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406 Rabbit Farm Trail Lot 6' DAVIE COUNTY HEALTH DEPARTMENT 4 Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003291 Tax PIN/EH #: 5870-41-6476.06 GW Billed To: George Warwick Subdivision Info: Rabbit Farm Phase 2 Lot # 6 Reference Name: Location/Address: Rabbit Farm Trail -27006 Pro osed Facility Residence Property Size: 5 acres ATC Number: 3814 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 a Tr tment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CO ST f O S ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: As stated in 15A NCAC 18A.11 accepted S stems may aisu uc uavu 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. qw(k L1 S+1LV1claV-d Ckaha>6- 3(�R I4-°usc, woo t- 2 S' Tank SROAF 1000 `D 5 S -r(3 ntPo V �1 loo tfD� bol S D' ly! o OL Septi System Inst By: Environmental Health Specialist's Signature : Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003291 Tax PIN/EH #: 5870-41-6476.06 GW Billed To: George Warwick Subdivision Info: Rabbit Farm Phase 2 Lot # 6 Reference Name: Location/Address: Rabbit Farm Trail -27006 Proposed Facility: Residence Property Size: 5 acres ATC Number: 3814 **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 2-- #Bedrooms _ #Baths Dishwasher: Jn`�— Garbage Disposal: ❑ Washing Machine: 0"- Basement w/Plumbing: lr Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply ��U-- Design Wastewater Flow (GPD) � Site: New Repair ❑ System Specifications: Tank Size 1000GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. Lk# STI � 2�As stated in 15A NCAC 18Aalso 1969(5) be used Other: `�Xl✓� accepted Systems may also be used Required Site Modifications/Conditions: � r� Ate-- r �i�, K� wi 1A �, ' ';�'' 9- � - VOMV • •.�v lU IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTIC Contact a representative oft}H unty 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 t}Jte day of i stallat%on. Telephone # is (336)751-8760.**** 3PO � I *d1�, I NDOSC:5� L{a Environmental Health Specialist's DCHD 05/99 (Revised) C��l DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section 7_ 2d' _X3 P. O. Boz 848/210 Hospital Street • Mocksville, NC 27028 r (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003291 Tax PIN/EH #: 5870-41-6476.06 GW Billed To: George Warwick Subdivision Info: Rabbit Farm Phase 2 Lot # 6 Reference Name: Location/Address: Rabbit Farm Trail -27006 Proposed Facility Residence Property Size: 5 acres **NOTE * per: 81 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 1 -100L -C #People Z #Bedrooms 3 #Baths 3 Dishwasher: u Garbage Disposal: ❑ Washing Machine: 0Basement w/Plumbing: E Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size /� ;S Type Water Supply � J ELI - Design Wastewater Flow (GPD) �CD Site: New � Repair ❑ System Specifications: Tank Size 10CCUAL. Pump Tank GAL. Trench Widt, 2-1 " Rock Depth 122 Linear Ft. qoo Other: ," SrAeA ,04 S Required Site Modifications/Conditions: / Al Sr4 — 6,j C . ' �I �'�� �-' L-)kLp kzol`� (� • LIJS 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.**** 3LZ NOOSE_ leo" 10s; 0S. M�r.�• Environmental Health Specialist's Signature: ^PMVIV-1 IM � I *5w) Lo4 w 09 ?* a 05/99 (Revised) May 27 04 12:50p ountu envhealth 336 751 8786 p.l *^ ...3 n U.. O/\((PUI. 'F It SITE EVALUATION/IMPROVEMENT PERMIT & ATC 2 UJ``tt avie County Health Department nvironmenta/Hea/t/f Section P.O. Box 848/210 Hospital Streot �iV1RON�^E�TALH�L Mocksville, NC 27028 pV1ECdU��� (336) 751-8760 ** ANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. t •` n, 1. Name to be Billed (�.JtLf LlitiL1_. contact Parson %qS,4)- fr ... Mailing Address Home Phone City/State/ZIP 'Zj,V:`�S �� �l�.i� Businoss Phone y03 -Moo 2. Name on Permit/ATC if Diffe::ent than Above Nailing Address _ City/State/Zip 3. Application For: ❑ Site. Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to service: )( House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested: X Conventional ❑ conventional modified ❑ innovative 6. if Residences N People 2. I Bedrooms -3_ t Bathrooms_ XDiahwasher ❑Garbage Dic;posal 1WWashing machine .gfBasement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes 1: Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Eatimated Water Usage (gallons per day) B. Type of water supply: ❑ County/City g Well ❑ Community 9. Do you anticipate additions or expansions of the facility (his system is intended to serve? ❑ Yes X No If yes, what type? ***IhfPORTANT*** CLIEPITS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. _Either a PLAT or SITE PLAN MUST SCSUBMITTED by the dicot with TMS APPLICATION. Properly Dimensions: WRITE DIRECTIONS (from Mocksville) to PROVERT1': 1'2x Office PIN: ll 5,F7 c, — 7/// Property Address: Road Namc"Ab TX- City/Zip � City/Zip If in a Subdivision provide inform::tion,,ass follows: Pamc: c 6 l >L F7iT /�%— Scct��Iocic ___ Lot: Date home corners Ragged: a�Q This is to certify (hat the Information provided is correct to the best of nny knowledge. I understand (bat any pernnit(s) issued hereafter arc subject to suspension or revocation, if the site plans or intended use change, or If the information submitted in this application is falsirrd or changed. 1, also, understand that fain responsible for all charges iucared from this applicatloa. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located (u Davie County and owned by to conduct all testing rocedur s a$ necessary to determine the site so' bility. DATE SIGNATURE al C+ TII1S AREA MAY BE USED TOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge � J ` LA—' -7 Datc(s): Client Notification Date: EHS: q Sign given Account No. / .d ilcciscd DCN (OS/03 /���� � Invoice No. 1- 1. Name to be Billed Mailing Address City/State/Zip APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT Davie County Health Department Environmental Health Section P. O. Box 848 i Mocksville, NC 27028 F.i� (336)751-8760rTBE ****IMPORTANT**** THIS APPL PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED l�eii V I�� Contact Person CN Home PhoU yo✓ A 6IJ , l 27 a 6l :2 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: 4. System to Serve: 5. If Residence: Q Dishwasher 6. If Business/Other: W" Site Evaluation [�✓ House # People r❑ Mobile Home J ff Garbage Disposal Specify type City/State/Zip ❑ Improvement Permit & ATC ❑ Business ❑ Industry #' Bedrooms ❑ Both ❑ Other # Bathrooms Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats , Estimated Water Usage (gallons per day) 7. Type of water supply: . ❑ County/City ❑" Weil ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 0 No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLA W. THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 504 07/ �4 1 WRITE DIRECTIONS (from �j l / / /,, 1 Mocl�sville) TO PROPERTY - Tax Office;PIN: # / 0 - r - lL • ID�D,EJ Property Address: Road Name R4 i _. City/Zip /-f /y✓_g If in Subdivision provide information, as follows: 0012,K Name:rC1✓,�Ji� �" �j�l�/2'L �• 1' Section:f ��if S Q Lot #: 1 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 CWounty Health Department to enter upon above described property located in Davie County 11 and owned by —fie 1 U r, to conduct all testing procedures as necessary to determine the site suitability. DATE _3Z 21qZ6q SIGNATURE Revised DCHD (06-96) YOU MAY USE THE BACK FF THIS FORM FOR DRAWIM5 YOUR SITE PLAN. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT'S NAME `-1' "" "AWL PROPOSED FACILITY SUBDIVISION"—' Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit SECTION I LOT G DATE EVALUATED PROPERTY SIZE �ose)i se ROAD NAME % Public Cut SITE CLASSIFICATION: �" J LONG-TERM ACCEPTANCE RATE: REMARKS: AV m4 6 FLSR 1avoq LEGEND DCHD (01-90) EVALUATION BY: Aaz OTHER(S) PRESENT: 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 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 position groupLandscape Texture ConsistenceHORIZON II DEPTH groupMineralogy Texture ■r�rr�wo�®� Consistence W14 -Al Mineralogy Texture group EN ' MIM �'M MAMMON �� 0 1 REM 0 5.���a MineralogyHORIZON IV DEPTH Texture group Mineralogy RIM, �'�r�Z�=E���r•����� SITE CLASSIFICATION: �" J LONG-TERM ACCEPTANCE RATE: REMARKS: AV m4 6 FLSR 1avoq LEGEND DCHD (01-90) EVALUATION BY: Aaz OTHER(S) PRESENT: 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 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 ■ilii■■■e■■■■i■■■■■■■■■■■■■■■■■■i■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■Mee■■M■■■■e■■■■■■S■■■■Mei■■■■■�■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■i■■■■■■■■■■■■i■■■■■■M■■■■iii■■■■■i■ ■■■iii■■■■■■i■■■i■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ON ■■■■■■■■■■■■■i■■■■E■■■■■■■■Oil■■■■■■ ■■iii■■■■■■■■i■M■■■■■■■■■■■■■M■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ilial■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■O■■�!1�■■■ilii■■ ■■■iii■■■ii■iii■i■■■■M■■c�E■■■■■i■■■ ■e■■■■ ■■ME■■ ■■■■PERSE EEME ■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■■■■■■■■■■■■■iii■illi■■■■■■■■■■■�■■ ■E■E■E■EMMM■■E■E■■N■■■■■■N■■■■M■MEMO ■M■■■■■■M■■■■■iii■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ MEMO MEMO NOME MEMO NONE MEMO MEMO MEMO MEMO ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■EM■EME■■ ■■M■■M■M■■■■ ■M■■■M■M■■■■ ■■E■■■■■■■■■ ■■■■MMM■■■■■ ■■■■MM■■■■M■ ■■■M■■■■■■■■ ■■■■M■■■E■■■ ■■M■■■■M■■■■ ■■■■M■■■M■M■ ■■MMM■MM■M■■ ■■M■M■■■■M■■ ■■■■■■■■■M■■ ■MMM■■■■■■■■ ■■MM■■E■■■E■ ■ ■ ME ON No ME i i i ON ii BE ii SEEM MEMO ■■E■ ■■E■ MEMO OVIAR ADO a llata9MA=)N OarlrKarf w M. 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IYI I 7 •S,_.r� r.r f+..a w.r.•a•..... ■yy, �T� 61 -71'7t4,111 41-ec.. -..... tillr//� r/ ,� .. • .••. ..•••- 11.. • v ir.-.r ♦. ...,4twJ \mar -1 u ♦ 77rA� Davie Gounty,,Health Department Environmental ,Health Section PO Box 848 / 210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 April 13, 1999 Mr. Vance Walser 201 Country Club Drive Lexington, NC 27292 Re: Site Evaluation -5 Acre Tract Rabbit Farm -Phase 2, Lot 6 Tax PIN #: 5870-41-6476 Dear Mr. Walser: As requested, a representative from this office visited the aforementioned site on April 9, 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. "SPECIAL NOTE: Due to some complex topography on this tract, the area available for installation of the system is limited. Additionally, placement of the house may require setting a pump station. 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. Sincerely, Jeff G. Beauchamp, R.S. Environmental Health Section enc(s)