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177 Rabbit Farm Trail Lots 1-2AUT$ORIZA,TION NO. I u DAVIE COUNTY HEALTH DEPARTMENT - Environmental Health Section PROPERTY INFORMATION Permittee's ,-,���' P.O. Box 848 Name: / �' I' Jv� Mocksville, NC 27028 Subdivision Name:ll rl� / Phone #: 704-634-8760 Directions to property: /, / f ; s:-;1? Section:-- Lot: AUTHORIZATION FORWASTEWATER - Q SYSTEM CONSTRUCTION Tax Office PIN:#D 1'7'7&C/JII- Road Name: 7-.cb�5K—tViIip: Gi/ df **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTA HEALTH'SPECIALIST DATE ISSUED 1 %) DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Pertnrt_tee:s. �' � .,•. ,',.• Name ,elrix Subdivision Name:r'I fadLjlr` Z?/. Z? Directions to property: `- ! r'` _ Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:# Road Name 1; 1{`! I t 4f, :Zip: **NOTE** This Improvement Permit DOES NOT authorize the construction or installation 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) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTI-I`SPECIALIST DATE ISSUED '' - SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS 1/ # BATHS Q 5""# OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No 1•� r LOT SIZE TYPE WATER SUPPLY ' DESIGN WASTEWATER FLOW (GPD) lJ NEW SITE -­ REPAIR SITE 10 SYSTEM SPECIFICATIONS: TANK SIZEa"� GAL. PUMP TANK GAL. TRENCH WIDTH7 \ _� ROCK DEPTH /9 LINEAR Fr.,.75W r /W REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT 7 "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALL BY: �r AUTHORIZATION NO. U� 5 OPERATION PERMIT BY:� DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 05/96 (Revised) ' APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMI j ` , . Davie County Health Department ��- Environmental Health Section 70 -J/PS�o. Box 848 �' JUL 2 3 1997 �d3P Mocksville, NC 27028 (704) 634-8760 ►1 rL--- I ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED. INFORMATION IS PROVIDED. >Pe 1. Name to be Billed K- T- TSPnhrnir constructin C6ontact Person Lee Riddle %�� � �0 Mailing Address 3401 Healy Drive Home Phone 940-2040 City/State/Zip Winston—Salem NC 27103 Business Phone 659-8211 2. Name on Permit/ATC if Different than Above mobile 345-1041 Mailing Address City/State/Zip 3. Application For: [X] Site Evaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [X] House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People # Bedrooms 4 # Bathrooms 2 1 2[X)Dishwasher [XXGarbage Disposal XM 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 [x]AVell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [XXlo If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** XT4MWOF THE PROPERTY MUST BE I SUBMITTED WITH r APPLICATION. Property Dimensions: F-333, B— 3' S d 71 1 0 4 " WRITE DIRECTIONS (fromksville) TO PROPERTY: Tax Office PIN: # 5870 - 62 - 4594 Hwy 158 E to 801 S to Advance Property Address: Road Name Rabbit Farms � Turn right on Cornatzer Rd Go appmax 1 mile City/Zip Advance NC ; Rabbit Farms on left, go across If in Subdivision provide information, as follows: railroad tracks & bear right --aTp-rax 100 yards, stte one left Name: Rabbit Farms Section: Phase III Lot#: 2 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 thi Representative of the Davie County Health Department to r upon a ove d by c n s n Biu DATE 7-99-97 SIGNATUR i* Revised DCHD (06-96) THIS AREA MAY 13E USED FOR DRAIVING YOUR SIZE PLAN: I ipplica on. I, hereby, give consent to the Authorized -ibedYessary operty located in Davie County and owned as ne to determine the site suitability. fU1. � tu4w► w Glilnilll • � .. 41540 w c".cw-• (uor/ 1 fso)e 1,2 - 7-=: t elf •• `•f �' � �� 0 t•• I. 1 •�• +•ar s•tel 1 i i C * � �►f.eti • ted( � � � V1 � � - � -� .II i e1:G•� V• zc.c+ — -c, t.ai►c• -• • 4A 14.0. 3 :r ""w�r:.s• P'� a 14.0•sss v FIZLO J a • . ._ Sss•o•t'w •R�A,p- IAstsa.• �,�•� �''.'la•• �� �,i••�. O ea ��I tt• ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME L.— DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION //r' J%'1 iL ROAD NAME Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC Consistence i Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 71 LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (O1-90) EVALUATION BY: G OTHER(S) PRESENT: 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 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 ■■■■■■,lam■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ��MENNENMEMM%N MEMEMEMENNENENMEMEMOMMEM 'V APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMI Davie County Health Department Environmental Health Section AUG 3 01996 P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By �J Am Mailing Address Home Phone /%04,7- .eAte., :�i 00 t'n Business Phone 2. Name on Permit if Different than Above --- _..._.._.__._�._._.._.______._____.__ 3. Application for: V( General Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: 0 House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ) ❑ Other ❑ Unknown -7 5. If house, mobile home: Subdivision /�LQ`y'1% Section �_ Lot # ?� ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms 3 -'Washing Machine No. of Bathrooms _...___.__—_ 8 -Dishwasher Dwelling Dimensions ET -Garbage Disposal 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: ElPublic B Private 8. Property Dimensions ___��-h�� Sewage Disposal Contractor 0 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes N No If yes, what type? ❑ Community e - *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. Directionsto Property: / /J <// E4 5 r� PORA' i Tax Office PIN: #5y7Q-,Io?-//?91) PROPERTY ADDRESS, as follows: Road Name: F �, f Ci ty:I/, /- SUBMIT 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. R12. I DO NOT QWN 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 representative of the Davie Co my Health Department to enter upon above described property located in Davie County and owned by _!� ➢ <](— to conduct all testing procedures as necessary to determine said site's suitability round absorption sewage treatment and disposal system. DATE SIGNATU DCHD (1193) `dq IHSNIZ15 'M rrtnl rLLia1C, �o .n:� i.3S �nAafO n 2 S£ N I - a b 0 �:J- /-. 7 0 7 2-- -- 9 a I� o r h.2D1 1 - • Q I lz011 `dq IHSNIZ15 'M rrtnl rLLia1C, �o .n:� i.3S �nAafO n 2 S£ N I - a b 0 �:J- /-. 7 0 7 2-- -- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Aez NAME fGti��O DATE EVALUATED ADDRESS PROPERTY SIZE/ -- PROPOSED FACIILTY 6 LOCATION OF SITEi.(J Water Supply: On -Site Well f/ Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 Landscape position .L Slope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC Consistence - Structure S Mineralogy 'I HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION d LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: -X 17'I;VALUATED BY: 6LG/ LONG-TERM ACCEPTANCE RATE: --� OTHER(S) PRESENT: REMARKS: 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 Texture 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-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 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 DCHD (01-901 Davie. County Health Department and.Come Health Agency Environmenta[Health Section P.O. BOX 848 / 210 HOSPITAL STREET COURIER #09-40-06 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 September 23, 199E James Atwood 187 Senora Dr. Advance, NC 27006 Re: Site Evaluation Rabbit Farm III/Lot 2 Tax PIN: #5870-62-4820 Dear Mr. Atwood: As requested, a representative from this office visited the aforementioned site on September 23, 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 have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd Enclosure(s)