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434 Rabbit Farm Trail Lot 7DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003402 Tax PIN/EH #: 5870-41-6240.07 Billed To: Byron Carter Subdivision Info: Rabbit Farm Two Lot # 07 Reference Name: Location/Address: Rabbit Farm Trail -27006 Proposed Facility Residence Property Size: 267 x 871 ATC Number: 3941 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 WASTEWATER-CU1 RAS VAIJ. b FORA PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: CERTIFICATE OF COMPLETION 1G O **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. Septic Syst( Environmental Health Special DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 f d o 5- (336)751-8760 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003402 Tax PIN/EH #: 5870-41-6240.07 Billed To: Byron Carter Subdivision Info: Rabbit Farm Two Lot # 07 Reference Name: Location/Address: Rabbit Farm Trail -27006 Proposed Facility Residence Property Size: 267 x 871 ATC Number: 3941 **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 H0#People --5- #Bedrooms _ #Baths Is Dishwasher: 2/1, Garbage Disposal: M Washing Machine: 121"' Basement w/Plumbing: K" Basement/No Plumbing: ❑ Commercial Specification: Facility Type .,#>People #People/Shift (�#jSeeants Industrial Waste: ❑ Lot Size !`A� ype Water Supply I, Design Wastewater Flow (GPD) Site: New Repair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth 1 -2 -"Linear Ft. Other: Required Site Modifications/Conditions: I �T�LLL 0-3 C-0-ym,2 I bcx�l FP -01 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.**** Environmental Health Specialist's DCHD 05/99 (Revised) APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department �® EnwronmentaiHeaith Section OFC c4' P.O. Box 848/210 Hospital Street Mocksville, NC 27028 24 (336) 751-8760r?p=%t1� ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE t- IJ/ INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN forinstructio �y 1. Name to be Billed ��/ 04 (�• lU r-/� 11 Contact Person ROM CA Mailing Address 001 &4 re /�,' Vl�rnC Home Phone 3 R 39/— V'6 8r City/State/ZIP W i i % II zn- S- C, N C 3-2 10 3 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation City/State/Zip lE"'Improvement Permit/ATC ❑ Both 4. System to Service: [t'H^/ouse ❑ Mobile Home 13 Business ❑ Industry ❑ Other ltd 5. Type system requested: Conventional ❑ conventional modified/ ❑ innovative 7 6. If Residence: // # People # Bedrooms ` ,7` #��B/athrooms J (�shwasher MGarbage Disposal Mashing Machine 93Basement/PlumbingooA asement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks _ # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats S. Type of water supply: ❑ County/City Estimated Water Usage (gallons per day) VWell ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ffl"&�o If yes, what type? ***IMPORTANT*** CLIENTS MUST C0,11PLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 26 / x d / / WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # SS70'- If� — (2 y0. �00� 1573 C�vwar� AdUawl�) z Property Address: Road Name o 4 r7a b %� F�nTrai City/Zip__Pocwe . ,fc 2 -loo(, __ 4'u no Z��-1 ..._oJ. eon,' -4z« G" - If in a Subdivision provide information, as follows: Name: Ra Farv✓- 11 Loi Section: Block: Lot: _ Date home corners flagged: /.2 " / -O L/ 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 ant 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 site suitability. /I DATE 1 Z - G , o �/ SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). SA VI'l a r— o h J a 9 9 1 Sign given /vim Revised DCHD (05103 Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. 7 ^� Invoice No. l �J APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIFFF7 Davie County Health Department Environmental Health Section P. O. Box 848 Mocksville, NC 27028 XX (336)751-8760 ENVIRONRIENTAL HEALTH ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED LIWES DAVIE COUNTY ALL THE REQUIRED INFORMATION IS PROVIDED. q Qg, 2l Z0 1. Name to be Billed H er m Lm -r bG c6r na. I --D V Contact Person ` 1 k i & ( 10A d Mailing Address 2 I'S 6 Y--& w 0 od t r i vt- City/State/Zip A A va n. ce- N G 2 -70ZI 2. Name on Permit/ATC if Different than Above Home Phone 7. 7 a _"2— ? 40 Business Phone 7 2 2- 4-2- 10 3 Mailing Address City/State/Zip 3. Application For: Site Evaluation ❑ Improvement Permit & ATC ❑ Both 4. System to Serve: .2( House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People -+ # Bedrooms 4 # Bathrooms 3 ,,Dishwasher ,Garbage Disposal Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/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 ell ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? E I THEK A FLAT UK 6 LIE MAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A TA)MM THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 21 '7. 43 X 8 71.34X,2 67.43 "X 9 7/- 3-P1 WRITE DIRECTIONS (from ocksville) TO PROPERTY: Tax Office PIN: # 519 0 --414- 4— - � Z �-� • ��� f � n � 67,Property Address: Road Name 1 -of ?Robb 14- Fav'm P,ccu ( � has Le /�_ C,� t � � � 1 rna�z.e-ae.1��u �yaneQ , IU G .�-�� � 1 �..�— City/zip ; �pb Farm I ra i If in Subdivision provide information, as follows: 1 n O - 17 Name: cow - far t^n 1 K l 1 Section: 1 �— Lot #: / 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. 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Environmental Health Section 'APPLICANT INFORMATION Soil/Site Evaluation PROPERTY INFORMATION Account #: 989900302 Billed To: Herman & Decoma Love -Lane Tax PIN/EH #: 5870-41-6240.000E Subdivision Info: Rabbit Farm II Lot # 7 Reference Name: 1 Location^-/�Addrreess: Rabbit Farm Trail -27006 PROPOSED FACILITY:' CC � J�% DATE EVALUATED: l PROPER? -y SIZE: Water Supply: On -Site Well Community Public ,Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca a position Slope % 7n> HORIZON I DEPTH — Texture group4- L_ &A_ Consistence 55 lr<_555 SS Structure Mineralogy /.- I:1 Ff HORIZON Il DEPTH _ o I (p - 2-4 Texture group G G Consistenceccs iv Structure Mineralogy HORIZON Ill DEPTH - Texture group C +5 P C 0, 5""//, Consistence Structure IG Mineralogy HORIZON IV DEPTH Texture group P Consistence Structure ---- Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION FK LONG-TERM ACCEPTANCE RATE 0. ZF o . SITE CLASSIFICATION: . (.�2 LONG-TERM ACCEPTANCE RATE: - Li REMARKS: LEGEND Landscape Position EVALUATION BY: 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 pis 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 (Revised 11/98) ■■M■EM■M■ ■■■■■■■E■ ■■■■E■ ■■MON■ ■■N■E■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■ecce■■■■elle■■■■■■■■■■■■■■■■■ ■eee■■■■■MmenM■■nMllm■■monemmN�IMMMNM■ ■Nmm■■■■■M■e■■■■n■IIS■Mn■N■■■■ ■■MONS ■■■■Nm■■m■■e■nmm■mllm■MEMN■m■mnEM■EMM■ ■■■■■■■■■■■■■■N■■Mil■N■■■■e■■■ ■EONS■ ■■■■■■■■■■■■■S■■■ ■■EE■■E■MEEM■m■e■ ■■M■M■M■M■OEM■E■■ ■■■■E■■■E■E■■■■■■ MNEME■■■■M■■M■■■■ ■■MM■■■MMEMMEM■■■ ■■■ MEN mom ■ ■■ t ■EN■■■ ■EMNO■ ■■■NE■ ■■■NE■ ■ENNE■ ■■MNO■ ■ENNE■ ■■EME■ no no SAME ■ISE■ ■IN■■ ■■MNON ■MIS■M■ ■■ISN■■ MEIN■■■ ■■Il■■■ ■■MNON MEIN■■■ M■MNON ■MINMEN ■MINM■■ Solo■E■ MEMO moon ■ No s � - Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC 27028 January 20, 1999 Herman & Decoma Love -Lane 213 Brentwood Drive Advance, NC 27006 Re: Site Evaluation/5.35 Acres Rabbit Farm II/Lot 7 Tax Office PIN: #5870-41-6240 Dear Client(s): As requested, a representative from this office visited the aforementioned site on January 7, 1999. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Environmental Health Specialist JB/wd Enclosure(s)