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123 Meadow Creek Court Lot 32a - r r DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 990004348 Tax PIN/EH #: 5871-42-5212 Billed To: Sonoma Building Company Subdivision Info: Meadows Edge II Lot # 32 Reference Name: Rick Tozier Location/Address: Meadow Creek Court -27006 Proposed Facility: Residence Property Size: 0.72 ATC Number: 4673 C4 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. / U System Type: S.T. Manufacturet�� T— Tank Date -a Tank Size Pump Tank Size System Installed By:_t- K' IVu u -r% E.H. Specialist: Jz % LZjr2 Date: C 1-i ` 1 Fiery , kw y aa' 4 1 w S �Y Yl (Revised) 5�� 9,0 6c A t DAVIE COUNTY ENVIRONMENTAL HEALTH ` P.O. Box 848/210 Hospital Street W lI Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 990004348 Billed To: Sonoma Building Company Reference Name: Rick Tozier Proposed Facility: Residence ATC Number: 4673 Tax PIN/EH #: 5871-42-5212 Subdivision Info: Meadows Edge II Lot # 32 Location/Address: Meadow Creek Court -27006 Property Size: 0.72 Site Type: ❑New ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms _q_ # Bathrooms 3,57 People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size p,7'2 NCP -ES Type of Water Supply:21�ounty/City ❑Well ❑CommunityWell System Specifications: Design Wastewater Flow (GPD) 'Waank Size 160CZ3AL. Pump Tank GAL. r Trench Width Max. Trench Depth Rock Depth /� Linear Ft�`% Site Modifications/Conditions/Other: sogr'e t'— A` rp Contact the Davie County E!nvironlrnental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. or - Environmental Health Specialist DCHD 11/06 (Revised) ate 9 /V% • AP MSITE EVALUATION/IMPROVEMENT PERMIT & ATC (4 1 Davie County Environmental Health p P.O. Box 848/210 Hospital Street ?Q4� Mocksville, NC 27028 (336)751-8760/ Fax(336)751-8786 A plicaI ''o f ylg�l icOl tion/Im vement Permit Authorization To Construct(ATC) ❑ Both T e of Appfli�,RR�t1 ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility 'IMPORTANT " THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION. Name to be Billed Contact Person , c Billing Address ?U C3c-x ,sri $!s �— Home Phone a3c, -- 9'IT - tE8 T& City/State/ZIP iJi, 5-Jc;r., Sr,IF, r,)(. a403 Business Phone 331, - y�y- 7337 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged 15/ /V 0% NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name Sid Phone Number 336 - ` 0 --,33 Owner's Address vg 8/ 'C',Vs City/State/Zip 1,�1 •.�5 �i�-�t► G 37113 Property Address I%7PLJ Qtc) L1lee /L &tr-1 City N(/d Nh' e Lot Size 0,12, Tax PIN#�fjK7/_SfZ-5ZIL Subdivision Name(if applicable) 1C Section/Lot# f'343Y Directions To Site: Solguh clkL- a,• le. l , bc�.vcla,1pS-L • 5�,� �.�t„'� 6— c_khy, If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes I!gNo Does the site contain jurisdictional wetlands? ❑Yes ANo Are there any easements or right-of-ways on the site? ❑Yes iZNo Is the site subject to approval by another public agency? ❑Yes HNo Will wastewater othei than domestic sewage be generated? ❑Yes @No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms _ q # Bathrooms Garden Tub/Whirlpool i lYes ❑No Basement: ❑Yes f5No Basement Plumbing: []Yes KNo IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Squard'Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested:, KConventional 11 Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: .6- County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? fkNo This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification"and labeling of property lines and corners and locating and flagging or staking the house/facility location, proposed well location and the location of any other amenities. Property owner's or owner's legal representative signature Date Site Revisit Charge Date(s): Client Notification Date: EHS: Sign given ❑Yes ❑No Account #�Y� Revised 11/06 Invoice # r�r"� NOT F Or�o SALES R RECORDATION Curve Radius Chord Bearing and Distance Arc Length Cl 50.00' S 62'-01'-08" E 45.00' 46.68' EARL MYERS I LOT 31 i r 32 31431'-Sq.Ft,: / 4.722 Ac.+%- N 1'-20'=51"' W 48.75' -- N 89'-14'-57" W 175.41' EARL MYERS MEADOWS CREEK CT 50' R/W 1 LOT 33 50 25 0 50 MAP FOR SONOMA BUILDING &w WATER METER R/W RIGHT—OF—WAY SCALE COUNTY TOWNSHIP DATE PREC. RATI QS SEWER MANHOLE _ RUNNING WATER 1" - SW DAVIE FARMINGTON 8 MAY 2007 1:10,000 • * IRON FOUND IRON SET —E—f— OVERHEAD POWER LINE PROPERTY DESC: LOT 32 of "MEADOWS EDGE phase 2" PS 8 PG 259 O MONUMENT O POWER POLE PROPERTY LINE (eyed) MY SEAL AND SIGNATURE — — — — PROPERTY LINE CERTIFY THAT THIS MAP IS COE FORESTRY k SURVEYING JOB (not surveyed) THE RESULT OF AN ACTUAL P.O. BOX 36 07124 SURVEY PERFORMED UNDER DRAFTED BY - N.C. 27373 ® POINT NOT MONUMENTED MY SUPERVISION. MDC MDC PHONE/FAX (336) 769-4673 SURVEYED B DBC V E LU ENVIRONMENTAL HEALTH DA'JIE COUNTY 11:011 SITE EVALUATION/1hiPROVIIAIENT i'E1G1117' & ATC Davie County Health Department Ei1YirOi1ment&11&7 t/1 Section .0. Dox 848/210 Iiospital Street rlocksville, NC 27020 (336)751-07GO * * *MPORTANT * * * THIS APPLICATION CA.NIVOT DL 11ROC'BSSLD UIILESS ALL THE REQUIRLD INFORMATION IS PROVIDED. Refer to the INFORMATION DULLETIN fol: inotructioni. I Jade Associates II, LLC Alan Jones 1. !lame to be billed Con Lac L Person ,__., nailing Address Post Office Box 4062 Volae I'bunc City/:,talc/'LIP llinston-Salem' DUJine:lJ 1'l�urrc NC 27115-4062 (336) 759-9688 2. Pamo on Permit/ATC if Different than Above Hailing Address City/Stale/Zip — _.—.__._.....-._.__.._._.. J. Application For: M Site Evaluation i ❑ ItnprovernenL- PeLinit/ATC ❑ 130th 4. System to Service: 12 House ❑ 110bile Home ❑ DujillcLD ❑ Industry ❑ 011ier_- ti 5. Type system requested: ii4 Conventional ❑ conventional modified ❑ innovaLive 6. If Residence: 11 People 4 I) Bedrooms 4 11 bathrouln:, 2.5 bDioliwasher InGarbage Disposal nWashing Machino M1)a::CIaenL/Plumbing ❑Dat cmcnL/!lo I'lunibirrg 7. If Dusiness/Industry /oLhor: verify type It People O !;illks 11 Commodes 1) Showers 11 urinalu 11 WaLcr Cooler:r IF FOODSERVICE: It Seats EDtimated Water U::agc (gallons par day) 8. Type of water supply: in County/City ❑ Well ❑ Couuuunity s. Do you anticipate additions or expallSiotis of the faCilily this SySlelu is ilnlcntled to servd: ❑ Yes 1q No If yes, irha( type? '**IM P01MINT*** CLIL:N'rSd1USTC0AIPLL•'TG'r1IL 1tGQUIItL'D I%01'L:l(TY 1NFORNIA'I'lON Itl QUE'STE'D JEL011'. Eithera PLAT orSITE PLAN UUSTUESURU17-TED by the clicol with THIS APPLICATION. 1'rupert), Diulcusiuns: T:nx office PIN: /l See attached map 5871615955 Property Address: Road Name Beauchamp Road City/Zip Advance, 27006 Ilia a Subdivision provide iul'urmation, as follows: Nadas: Proposed Jade Associates Section: Bloch. Lot: 32 ldltl'fE UllwCTIOP(S (I•ruin Mucicsville) lo 1'ROP EItTV: East on flighway 158; turn right onto Gun Club Road and proceed to the end of the road, turn left -onto Beauchamp Road and the site is located approximately two Miles down Beaucharip Road on the right and left side of the road. 3/8/04 Datc honic corners flagged: This is to certify that the information provided is correct to the best of toy l(nowicdge. 1 understand that :ull' permil(s) issued hcrcaf(er arc subject to suspension or revocation, if Ute site plans or iPntendcd use cltailge, ur if the iuforuun(iou subulittcd ill this application is falsified or changed. 1, also, undetsYand that I aur respunsihlc fur all charges inc•rn•rrrl from this application. I, hereby, gii•c conscut to the Authorized Representative of (he Dane Cununl), 11c:11tlf Det 1 -hl 1 l to cuter upon aboi'c described pruperty lucaled ill Davie County and uwtned by Jade Ass Ocl ates , G to Conduct all lesting proeedul'u a5 necessary to de(erutiue (he SIN, seta II(y. 3/15/04 DATl: ' �iL�^.% SICNA I'Ulzl, THIS ARLA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of (lie fullotring: Existhig ;old proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Cha►'ge Da(c(s): Client Notificalion Date: EMS: Sign given Avrnnnf Nn s DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003105 Tax PIN/EH #: 5871-61-5955.32 Billed To: Jade Associates II, LLC Subdivision Info: Prop. Jade Assoc. Lot # 32 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map Date Evaluated: �� t z_jgq Water Supply: Evaluation By: On -Site Well Auger Boring_ Community/ Pit r/ Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position (L,- L_ Slope % t ,Zo HORIZON I DEPTH Zto Texture group Consistence Structure 3 Mineralogy HORIZON II DEPTH Texture group Consistence SS , Structure Mineralogy; I HORIZON III DEPTH Z C1 Texture group S; L S. Consistence 5 >a Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE C L SITE CLASSIFICATION: V 1 LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscaue Position EVALUATION BY: �S� tR �-P 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 05/99 (Revised)