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316 Rabbit Farm Trail Lot 2" DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section / P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990002126 Tax PIN/EH M 5870-42-7662 Billed To: Donald Maurice Subdivision Info: Rabbit Farm 2 Lot # 2 Reference Name: Location/Address: 3164 Rabbit Farm Trail -27006 Proposed Facility: Residence Property Size: 370'x690' ATC Number: 3057 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People 't]/ #Bedrooms #Baths Dishwasher: )21Garbage Disposal:,Z Washing Machine Basement w/Plumbing:;!fBasement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size�(� Type Water Supply 44JI Design Wastewater Flow (GPD) e,j6 Site: New 1211" Repair ❑ System Specifications: Tank Size /,UP GAL. Pump Tank GAL. Trench WidthRock Depth _f Linear Ft. Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** P n1 A44�e /B/1 rt C,? -/6 '02 Aa se-fle A/ Environmental Health Specialist's Signature: 0 DCHD 05/99 (Revised) IV Date: �2 Account #: 990002126 Billed To: Donald Maurice Reference Name: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5870-42-7662 Subdivision Info: Rabbit Farm 2 Lot # 2 Location/Address: 3164 Rabbit Farm Trail -27006 Proposed Facility: Residence Property Size: 370'x690' ATC Number: 3057 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE W R CONSTRU TION IS V D FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 119 - –PZ— CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article I 1 of G. S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Q ra– r Environmental Health Specialist's Signature :�� Date: �� S f% DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMiT Davie County Health Department Environmenta/Heaith Section N� , P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed NUAIA Koo21C� lR. \ Contact Person JAHL Mailing Address 123 1zlveev'�i t, %w u a,��Jt u2. Home Pho 2f- City/State/zip fcity/state/zIP AAn-u- NL 2.100 1. Bn� secs Ph 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation City/State/Zip Improvement Permit/ATC Both 4. System to Service: W House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People L' # Bedrooms .S # Bathrooms S Dishwasher >6Garbage Disposal Washing Machine 4 Basement/Plumbing U Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Commodes # Showers # Urinals # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City X Well ❑ Community 8. ` Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 4No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PIAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 31 0"< 00 ' Tax Office PIN: # 5 (3- �� �� 2 Property Address: Road Name 3 � � RA6 V '�aan Tm, I City/Zip Qovwuc-k- NC -L-1006 If in a Subdivision/ pr9vide information, as follows: Name: E. 6 , Section: Block: Lot: "_ WRITE DIRECTIONS (lfromn \Mocksville) to PROPERTY: on -6 C,,AgT?_Q9-- V ow-'�o R46b►J� Fwg-5 1off IL— Date Property Flagged: \ 6 This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of theavie County Health_ Department to enter upon above described property located in Davie County and owned by GN"1 d M�lu+z' (r TZ, to conduct all testing procedures as necessary to determine the site suite ility. DATE ZS- o Z SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property tines and dimensions, structures, setbacks, and septic locations). 1 Revised DCHD (07/99) �; ('t. 0 S., 4 a Account No. � Invoice No. !q7 %000 -, N JG4I SHEO 165' oWELL [If umloc APPLICATION FOR SITE EVALUATION/IMPROVI Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, NC 27028 1.* Application/Permit Requested By Mailing Address nr 2. Name on Permit if Different than Above 3. Application for: 4. System to Serve: 2eHouse U) "@[EOV S PERMIT f -.1 1996 Home Business ,�, Evaluation d Septic Tank Installation Permit ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision �a,Ql r r Section �_ Lot # R/Basement/Plumbing No. of People No. of Bedrooms 3 No. of Bathrooms Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Sinks No. of Urinals No. of Water Coolers No. of Showers Water Usage Figures _ 7. Type of water supply: ❑ Public �r" " . Private 8. Property Dimensions S �V kgcke Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Yes ❑ Basement/No Plumbing Rr Washing Machine p"Dishwasher ❑ Garbage Disposal No ❑ Community 'NOTE: Improvements Permits shall be valid from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: r �CL�� PaL�r� �,� -4-0 - PQV,�-J a wul"a I Tax Off i cc PIN: # �' c ? 0 — PROPERTY ADDRESS, as follows: { Road Name: .IAI Zf-�it � City: SU13MIT A PLAT WITH THIS APPLICATION. Revisions effective October 1, 1995. This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. � DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. 2-'2I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representativ th Davie Coun�tyy Hea�lt.hDepa ment to enter upon above described property located in Davie County and owned by I -F • t-fo-r3-�-•�� c<Q to conduct all testing procedures as necessary to deter ine said site's suitability for a ground absorption sewage treatment and disposal system. —2- PV Tv -t - DATE SrrGNATURE DCHD (1193) i r I Yl, q 471 as DuAffrMuffoFTFAMO/Oft AMN - Ianrlurf as f•f ur.r.0 w.� t-t•S]EMAaLA Gate!)=w.r/wlwrlrwra.n - O•aw"1►•rr — CMYlffdl °.1/0IIMtTt . t. •.e. w..lh ""n.wr.N..,....r,•rr,.ww..ww.rwr..n «.w w�a Eot�c«t - �' � . _ �= � l.u[af w.7` `,-tom o w••'••a••• �'I (--`. A.,. woofefnaaa�afor - swsauflai iw Hilt faiwr. crcuarw'w r. r.+ ,. rw•rN.~•ww.+r.w.,�i.. r..r.".. LLll.r•.y.r.aw.r l�M M�`�'t.fSw...icf.~. 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'Q�i.V6 1► oOQT10N aw Vf 1.•2• T.eY •M� G.d ew..ae w �e.w K. N•••,, a4•C P.ti. 6, oc.H �. 142. PCA . - � } DI Cf_Maa1 Irl SC wla.l•.200 •• •'• � M.ae 4; lw1L 7t'7 6121wNaVawG 4. 7=7 Qais, ws _ WaV4T0.1 sq�aM, Y.G• Y7103 722•CS4.. DZme AeAK Devgrfinent 210 HOSPi l"Ai. STnCET P.O. BOX MOCKSVILLE. N.C. 27028 PHONE: (704) 634-5985 i Auaust 07, 1996 Jerry Burnette- Hubbard urnetteHubbard Realty 5342 Hwy. 158 Suite 1 Advance, NC 27006 ATT: Betty Potts Re: Site Evaluation Rabbit Farm II Lot 2 Tax PIN: 415670-42-7662 Dear Mr. Burnette: As requested, a representative from this office visited the aforementioned site on August 6, 1996. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. If you haveany questions, please feel free to contact this office. Sincerely, Charles E. Little, R.S. Environmental Health Section CEL/wd Enclosure(s) DAVIE COUNTY HEALTH DEPARTMENT r Environmental Health Section Soil/Site Evaluation q q NAME �s��-� `� �� �>�`cs� DATE EVALUATED /1 ` ADDRESS PROPERTY SIZE PROPOSED FACIILTY \�o uSQ LOCATION OF SITE Water Supply: On -Site Well ✓ _ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position .5 Slope R T - IS " S HORIZON I DEPTH Texture groupL Consistence PT\"J Structure C Mineralogy HORIZON II DEPTH Texture group Consistence I L - Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S RESTRICTIVE HORIZON — SAPROLITE CLASSIFICATION 5 LONG-TERM ACCEPTANCE RATE 3 SITE CLASSIFICATION: 'CE> LANG -TERM` -ACCEPTANCE RATE: REMARKS: ` 54 - � '110 DCHD (01-901 EVALUATED BY: D �� OTHER(S) PRESENT: o N S2 LEGEND Landscape Position R -Ridge S. -Shoulder L -Linear slope FS -Foot slope N -Nose slope CC -Concave slope CV -Convex slope T -Terrace FP -Flood plain H -Head slope S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt SICL-Silty :lay loam SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- V+ ---y friable FR -Friable FI -Firm VFI-Very firm EFI-Extremely firm Wet NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky NP -Non plastic SP -Slightly plastic P -Plastic VP -Very plastic Structure 3C --Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2