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389 Rabbit Farm Trail Lot 20• DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900195 Billed To: Richard Poindexter Reference Name: Jeff & Tara Allen Proposed Facility: Residence ATC Number: 2935 Tax PIN/EH #: 5870-51-5710.rp Subdivision Info: Rabbit Farm Phase II Lot # 20 Location/Address: Rabbit Farm Trail -27006 Property Size: see map 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 d Disposal Systems). THIS AUTHORIZATION FOR WASTEW T SON IS LID ORA PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa e: 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 11 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. was - F�wy-1boc 21 -29 - Septic System Installed By: Environmental Health Specialist's Signature: DCI -ID 05/99 (Revised) 70,00 LrQe,nl 07- C&%- c. e 47" i,,,IS1�01-C,n,9j V D� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street q / Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900195 Tax PIN/EH M 5870-51-5710.rp Billed To: Richard Poindexter Subdivision Info: Rabbit Farm Phase II Lot#20 Reference Name: Jeff & Tara Allen Location/Address: Rabbit Farm Trail -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2935 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a 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 "UjSC #People 3 #Bedrooms 3 #Baths 2 Dishwasher: rY Garbage Disposal: ❑ Washing Machine: lid Basement w/Plumbing: Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size - ACPF�S Type Water Supply ALL- Design Wastewater Flow (GPD) 25W Site: New 91"� Repair ❑ �► �.2,_,.,r System Specifications: Tank Size 1� GAL. Pump Tank GAL. Trench Width Rock Depth � 2 Linear Ft.:.�C� �, F Other: ;3 ,U `2TfZA n0 J 01c i 1►1JSTi�t- (�,� Required Site Modifications/Conditions: 4a I- Do-- I oosc, L t+��TAU. Ont '(&�o L, ��–p —� 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.**** ri (�orvT 5 .Sfoa� !Q;i T�A . n e'xL� �o STA 6 ZSR TO SIp� Pap. �a 1p Environmental Health Specialist's Signature e: ©/ ✓ DCHD 05/99 (Revised) JUL 3 0 20 ENVIRONMENTAL HEAT IN FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environments/Health Section 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 P VIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed' rl 17 CV-7,Ct— /' Contact Person 99 r, Mailing Address A ( / �/ Home Phone / j c City/State/ZIP 2. Name on Permit/ATC if Different than Above La Mailing Address 3. Application For: ❑ Site Evaluation Business Phone Improvement Permit/ATC ❑ Both 4. System to Service: X House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms '— # Bathrooms X Dishwasher ❑ Garbage Disposal AI Washing Machine L4_-Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City frWell ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ANO If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: sa C -/-{'S Tax Office PIN: # 5 �--7 0 — .51— S7�V TP Property Address: Road Name c R'J- �'h/7 / y ,--IrL City/Zipa c P lV°C, 7006 If in a Subdivision provide information, as follows: Name: Section: Block: Lot: .20 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date Property Flagged: 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 the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the s i bility. 4� DATE SIGNATU .� THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Incl de all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Revised DCHD (07/99) Date(s): Client Notification Date: EHS: Account No. / J Invoice No. ��� APPU(A11ON FOR SITE EVALVA]ION/IMPROVEMENT PERMIT & ATCLK L5 O V l5 i / " Davie County Health Department EnWtmnmenfal Healffi Serdon ��p y P.O. Box 848/210 Hospital Street WR 2 2 Mockaville, NC 27028 F1 (3361751-8760 RIVIRM11. ffAL HEALTH ***IMPORTANT*** THIS APPLICATION CWMT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION I3 PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Hams to be BilledI er /� -( e � f.'LL,e� / "' Contact Person Nailing Address _ J//_ � L�.ZY 0 —1-41 L' same phone City/state/sip Az;, A� i Z%ooh Business Phone Z -T9 0 ZZ. Name on Pewit/ASC if Different than Above Nailing Address City/state/Lip 9. Application For: �o'�site Evaluation 0 Improvement Permit/ATC O Both 4. system to service: ErHouse C Mobile Home 0 Business 0 Industry 0 other a. If Residence: # People 2'S # Bedrooms _T_E.= # Bathrooms 3 ,6(Dishrasher Zi Garbage Disposal X6 Nashb q Machine d`Bases+ent/Plmbinq 0 Basement/No plumbing 6. it BusinemrfINAMstry/other: specify type # People # sinks # Commodes # showers # Urinals # Nater Coolers IF FWDSERVICE: I Seats Estimated Nater Usage (gaiions per day) 7. Type of water supply: 0 County/City Id Nell 0 Community e. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes 0"No If yes, what type' ***IMPVRTANT*** CLIENTS AIUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. ' Property Dimensions: Z SD A $ 3�DIRECTIONS (from MockrAlle) to PROPERTY: `7. o Tax Office PIN. k 459-7O - rJ S'1 I (7 ,06 1i -r . �� it I a• Property Address: Road Name Tli rr 4am TEAL b01 S614TA e141A-V 0,.1 c"r-MP�T`Z�tL_ Citymp QbdA1%16Z 4 2i7tX) ?D A-PP¢oec J)rje ✓ % i L F= , C.2C-T W in a Subdivision provide information, as follows: D^) Qk e Pi ri rA -wi 12 t- . Name: X4.88 IT, Block: Lot: Date Property Flagged: This Is to certify that the Information provided is correct to the best of my knowledge. I understand that any permits) Issued hereafter are subject to suspension or revocation, if the site pians or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I on ro ponsible for all charges incurred fi+vnr this appUradon. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by jo-�oi� �5 r ire A C' to conduct all testing procedures as necessary to determine the site suitabiii DA'Z'E Z2 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the follo lug: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Y�a��h,� _ _ --- ��T 1 " 2So�1. oi��J� (its•" kA ' 3 0 07,00, 2 oe), Account No. 01 Revised DCHD (07/98) 13-7( invoice No. pk est s DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION 2 LOT 2�D Soil/Site Evaluation APPLICANT'S NAME "tz:� 4 DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION �) '{� ROAD NAME Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut SITE CLASSIFICATION: P) LONG-TERM ACCEPTANCE RATE. d 3 S REMARKS: dit�7 a1I. r2'i11 LEGEND Landscape Position EVALUATION BY: c OTHER(S) PRESENT: 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 Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very 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 SC - 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 DCHD (01-90) position HORIZON I DEPTH -rr��r_W ConsistenceLandscape .Mr�AV 55ME ■r.�.,� ■ria HORIZON II DEPTH ... Consistence-o��r�r�■������ HORIZON Consistence-r��r��r�zMIW"M � neraloEy MiCLASSIFICATION Texture group Consistence UM • I WON=WIM10 W.0i40rj01��� SITE CLASSIFICATION: P) LONG-TERM ACCEPTANCE RATE. d 3 S REMARKS: dit�7 a1I. r2'i11 LEGEND Landscape Position EVALUATION BY: c OTHER(S) PRESENT: 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 Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very 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 SC - 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 DCHD (01-90) NONE NONE moon NEON ■■E■ ■OE■ NEON MOON ■■E■ ■OE■ ■OE■ MEMO NEON NEON ■OE■ ■E■■ MEMO NEON MEMO ■ ■■■■ mom ■■■■ moon OMEN ■■E■ ■■E■ ■■N■ ■o■Il■■o■ ■E■INE■■■ ■■MINE■E■ ■EMIN■ME■ ■EMIN■■E■ ■EMIN■E■■ ■EMIN■■■■ ■■■INNE■■ ■■■Il■oo■ ■E■IN■■M■ ■■■IMM■■■ ■■■1N■■M■ ■■■It■■M■ ■M■1N■■M■ ■■■IN■■■■ ■■MIN■■■■ ■■■It■■■■ ■■■■■■■■oMM■■■M■MINI■ ■■■■■■■■■■■■■■■■■ ■ ■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ IIM■MEMM■M■■■■■■■■■■■■ M■11■o■ ■■Nil■m■ ■■NII■E■ ■■■limo■ ■■■Ilmo■ ■NEIINN■ ■■NII■■■ ■■E11■■■ ■omll■■■ ■mmll■■■ ■■MIN■E■ ■■■11■■■ ■m■llm■■ ■omllm■■ ■E■INE■■ ■M■IIM■■ ■E■IINE■ ■■■IINM■ ■■mil■o■ ■■EIIEN■ ■MME■M■MMENN■E■■■ ■NE■■M■■MEE■MENE■ ■MM■■E■■E■■■EM■■■ ■■E■■E■■■■■■EM■M■ ■■M■■E■■E■■■EM■M■ ■EM■M■■M■■■■■E■■■ ■E■■ENM■■■■■■M■■■ ■■E■■EM■■■■■■■EN■ ■R1■■E■■M1�1■■mm■■ ■ ■E■■■■ ■■EN■■ ■■■■m■■m■■■■■■■■■ ■■■■■■EM■■■M■■■M■ ■■■E■■EM■■E■EN■M■ ■■■ENO■■■■E■E■EM■ ■■NE■■EM■■E■E■■E■ ■■■M■■E■■N■■OM■■■ ■■NE■■■ENM■M■■■■■ ■OMM■■■NNOMM■■■M■ ■■■M■ME■■■EM■■O■■ ■■M■■E■■N■■M■■MO■ ■■■■mmo■■om■ommo■ ■■■M■■■ME■IME■■■M■■■ ■■■mm■■m■■11■■■o■■■■ ■■■■N■■MN■IINS■■■■S■ ■NEEM■■■■■11■■■■■■E■ ■OMEN■■■■■E■Noll■■■■ ■■■S■ME■■■■■■■11■■E■ ■■■S■■■■E■■■ENUMM■■ ■■E■■■■■■■■■■■ll■■N■ ■■■■■■■■■■■■■Nil■■■■ ■■■U■■■■0■■■■11■■■■ ■■■ ■■■■■■■■Nil■■■■ ■■■■■■■■■■■■■Nil■■■■ ■E■■M■M■■■M■■■IN■O■■ Davie Gounty,,Health Department Environmental Nealth Section PO Box 848 / 210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 March 30, 1999 Jeff Allen 119 Lazy B. Trail Advance, NC 27006 Re: Site Evaluation - Phase 2, Lot 20/Rabbit Farm Tax PIN #: 5870-51-5710 Dear Mr. Allen: As requested, a representative from this office visited the aforementioned site on March 30, 1999. Based on 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. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, you may contact our office at (336)751-8760. Jett u. tseaucnamp, tc.b. Environmental Health Section enc(s)