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125 Meadow Creek Court Lot 31DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990004019 Billed To: E.J. Hanes Construction Reference Name: Proposed Facility: Residence ATC Number: 4500 Tax PIN/EH #: 5871-42-4355 Subdivision Info: Meadows Edge Lot # 31 Location/Address: Beauchamp Rd -27006 Property Size: 0.81 ac 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 CON TRUC N IS V b FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa /----�X7::)ate: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate ofomp Cletloir shall indicate thesystem described on Improvementl0peration Permit has been installed in compliance withAdicle 11 of G.S. CbApter, 130X, Section-l�i0 "Swage Treatment and Disposal Systems," but shall in NO WAY beas a Melee that the system will functi satisfactorily for any given period of time. £�� I 7 VT 9 4 a L z � - - TO e 2 Ft-e�.3 (aaa ) it a3 L,, Septic System Installed By: Environmental Health Specialist's Signature: 4 Date: DCHD 05/99 (Revised) : DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 990004019 Billed To: E.J. Hanes Construction Reference Name: Proposed Facility: Residence ATC Number: 4500 Tax PIN/EH #: 5871-42-4355 Subdivision Info: Meadows Edge Lot # 31 Location/Address: Beauchamp Rd -27006 Property Size: 0.81 ac 125 ri/MeAD00 "L, -1L- C --r **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 FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specification: Building Type OO�;� #People 4 #Bedrooms 7 #Baths ,7•--�' Basement w/Plumbing: _ Basement/No Plumbing Commercial Specification: Facility Type #People #People/Shift #Seats Lot Size ©, Type Water Supply " j JMesign Wastewater Flow (GPD) � Site: New System Specifications: Tank Size GAL. Pump TankkWGAL. Trench WidthaZ Trench Depth!�W�� Rock Depth -P -Linear Ft.4Ct:� Other: Required Site Modifications/Conditions: 0.-3 C-&QIC . Contact the Davie County Environmental Health Section for 8:30 — 9:30a.m. on the day of installation. Tel ,00,31 dCap , � qo Environmental Health Spec i 'st� DCHD 11/06 (Revised) / 15 aF 1'-;C, - inspection of this system I ie # (336)751-8760. �v j:oa fi=t, 1 D, �fF �cli�• U- Xk , Ml -l. 10' w --U,x,275.95' 471.39', {MOM IRS Tp IRS • k.,. Zoo/ZooLL66OLL96C XVJ LE EO 9o0ZAL/ZL DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT(OPERATION PERMIT Account M 990004019 Tax PIN/EH #: 5871-42-4355 . Billed To: E.J. Hanes Construction Subdivision Info: Meadows Edge Lot # 31 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: 0.81 ac ATC Number: 4500 **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 TypeL�1T� #People "l #Bedrooms _ 14 #Baths Z Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0.Q)1 AIA'<C— Type Water Supply/D�Design Wastewater Flow (GPD) Site: New 71, Repair ❑ System Specifications: Tank Size /OGAL. Pump Tank/MVGAL. Trench Width ---RA Depth N -A Linear Ft. Other: Aa�—, �1�� Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISIIED 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 da�of installation. Telephone # is (336)751-8760.**** �l 37 �A o. + �o- Environmental Health ec list —DCHD 05/99 (Revised) �,�� L_Lr.1 � l ►J �i�'Z Rue 29 06 01:53p davie counts envhealth 336 751 8786 APPLICATION FOR SITE EVALUATIONIMIPROVEMENT PERMI- Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC VD28 (336)751-8760/ Fax (336)751-8786 Application For: C Site Evaluation in provem/ ent Permit IY Authorization To Construct(ATC) ❑ P-2 0 W E ` SEP 1 g 2006 ' ENVIRONMENTAL HEALTH r; DAVIE COUNTY '"IMPORTANT"* "* THIS APPUC IXION CANNOT BE PROCESSED l WLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed G.�. �ontact Person ���tcs Billing Address �. �a/j //t / Home Phone �— City/State!ZIP ,g -►I Z,7 Business Phone — Name on Permit/ATC if Different f tan Above Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey -plat or site plan nuj,,-. accompany this application. (Permit is valid for 60 months with site plan, no expiration ro Street Address____ Subdivision Name Directions To Site: Section/Lot# Date House/Facility Cc mers.Flagged `I'-1 V–a( P If the answer to any of the following gtu:stions is "yes", supporting documentation must be attached. Aro there any existing wastcwa ter systems on the site? OYe i *o Does the site contain jurisdictional wetlands? OYe:t )Vo Are there any easements or right-of-ways on the site? ❑Ye:. t lNo Is the site subject to approval by another public agency? ❑Ye::)(lo Will wastewater other than dor;estic sewage be generated? ❑Ye-:1*0 IF RESIDEN E FILL OUT THE BOX JJaOW �--� # People # Bedroutns It # Bathrooms gzLa Garden Tub/Whirlpool Wes UNo Basement: OYes o Basement Plumbing: OYes %lo IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business _ Total Square Foota.3e 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.-onventional ❑Accepted ❑Innovative OAhemative ❑Other Water Supply Type: Itounty[City Wat;r ❑ New Well ❑Existing Well O Community Well Do you anticipate additions or expausior s of the facility this system is intrude] to serve? O Yes C) 60 if ycs, what type? // This is to certify that the information pro rided on this application is true and correct to the best of ray knowledge. I understand that any pemiit(s) or ATC(s) issued hereafter arc subject to suspension or revocati-3n if the site is altered, the intended use changes, or if the information submitted in this applica ion is falsified or changed I undersivtd that l am responsible for all charges incurred from this application. I hereby grant tight of entry to the AuthorizedReprescittative of the Davie County Health Department to conduct neeary inspection to etc] *= lian -c li a ws and r#lcf o the above described property located in Davie Countyand owned b r CV b Site Revisit Charge or owner's legal repres-mlative signature Date(s):__ Client Notification Date: _ EHS: Sign given FlYes ONo Au:ount # Revised 2/06 / Invoice # Reef -sed -EV IL 578�Z (S211 Ol S?!I NOW) .6£'lL� ,96*gLZ" tp co �- y (J7 m 0 m W cotX Cin - U) %%.0 .-ARL E. MYERS I8 1121, PG 438 371421343, LOT 1 343 , ETON TOWNSHIP± P0 Cn IRS COVE TOWNSHIP± 0.94 acres f 4>> r8 �. 231..29 r ter B 0.81 acres f tZ 5 r� 32 0.72 acres f 175,41' X 0.70 acres o tv 74.13 , cpf \ 52.21 ' y Wzc So �- 0i 0 U) X S 89.1 Meadow Control omer 79.47' �bc A-` t 0 C)33 d- o - 0.72 acres f o 214.96' E E D NVIR�N,� HDAVETUN d 1011 SITE L•VA1­UATI0N/IAII'l10VL'A11:N'f PLRMIT & NX Davie County Health Department EnYiroilu1enta/Hea/t/i 5CCtron .0. Dox 848/210 HospiL•al Street 1•locksville, NC 27028 (336) 751-0760 * + * IMPORTANT * * * TIIIS APPLICATION CANNOT Dli PROCESSED U11LESS ALL THE REQUIRLD - I I11FORMATION IS PROVIDED. Refor Lo the INFORt•IATION DULLETIN for insL1:uCtionL1 Jade Associates II, LLC Alan Jones 1. !lune to be Dillcd ConLacL 1'crnon �— Mailing Address Post Office Box 4062 110111c 1'l,vne City/.;tate/'LIP 11inston-Salem, NC 27115-4062 UUJinI`:1n t'Ilu,ie (336) 759-9688 2. Name on Permit/ATC if Different than Above Hailing Addresa City/StaL'c/Zip J. Application For: M Site Evaluation ❑ IlnprovCment PCrl1liL/Al'C ❑ DuLi1 4. Syatem to Service: ® House ❑ 2Sob,ile Home ❑ Du ineLs ❑ Industry ❑ Other - - _- ti S. Type nystem requested: M Conventional ❑ conventional modified ❑ innovative 6. If Residence: It People 4 11 Bedrooms 4 It Bathroom:; 2.5 bDinhwanher tGarbage Dispoaal nNashing Machine I9Dascu,cnL/1'lu:nbiu;) ❑Dar;emcnL/Ilo Plumbing 7. If Duainass/Industry /other: verify type I) 1'cople I! :;ink:: I Commodes Il Showers It Urinals I! IVaLcr Coolcru IF FOODSERVICE: # SeaLD EDLimated Prater Usage gallons per day) __--- 8. Type of water supply: In County/City ❑ well ❑ ConuuuniLy��S 9. Do you anticipate additions or Cxp:U1Si011S Of the f:ldlily Illis systeill is ill(cLldcd to serfs? ❑ YCS DCV No if yes, what type? "IMPORTAIVY ** CLIENTS r11UST C0AIPLLTGTIIE ALiQUIRL•'D PROPERTY INFORMATION IWQIjl?STI."D tELOW. Eidicra PLATor SITE PLAN HUSTQCSUMU1T1CD by (Ile cliall lvilll'I'111J Al'PI,ICA'I'101i. Prvperly DiDlcllsiuns: 'Fax Office 1'1N: 11 See attached map 5871615955 I'rollcr(y Address: Road Na111c Beauchamp Road City/Zip Advance, 27006 If Ill a Subdivision provide inlurnia(lon, as follows: Nalllc: Proposed Jade Associates Scclioll: Bloc!:: Lot: 31 11'!tl l'B VIRL 'PIONS (from Aluchsville) l0 1'1tUl'liltTY: East on flighway 158, turn right onto rmn N (1h Rnarl and proceed to the end of the road, turn left -onto Beauchamp Road and the site is located approximately Wo miles down Beauchamp Road on the right and left side of the road. 3/8/04 Date hollle corners ILIbged: This is to Cer(ify that the inforluation provided is correct to the best of illy I(Ilowledge. I understand that .1113' pernlil(s) issued hereafter arc subjcct to Suspension or revocation, if Ulc site plans ur intended use Ch:rllge, ur if (lie iufurucl(iun subuli((cd in this appliC116011 is 1.115ilied ur ehangcd. I, also, ituderstand that 1 am respurlsihle fur all Charges incla-1-c11 fr•urrl thisapplicatiurr. 1, hereby, give consent to (lie Authorized Representative of the ll:lvic Cuuuly I lle:lltll 1)CL11 ill l 1 to slicer upon above described properly localed in Davie County and olvncd by _Jade Associ ates 11 , G to conduct all testing procedures as Accessary to de(erutine the site suitability. DA'Z'E 3/15/04 SIGNATURE 'I ?�' "'P—C`C�~� TIIIS AREA MAY BE USED FOR DRAWING YOUR SITZ; PLAN (mends all Of (lie fullorring: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign g;vell Site RcOsit charge ---- Client Notification Date: EIIS: Arrnn„1 N„ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003105 Tax PIN/EH #: 5871-61-5955.31 Billed To: Jade Associates II, LLC Subdivision Info: Prop. Jade Assoc. Lot # 31 Reference Name: Location/Address: Beauchamp Rd-270012-lCq Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit ✓ Cut FACTORS 11 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group 01 C Consistence Structure Mineralogy 1: 1I HORIZON II DEPTH -L0 1 '' Texture group -V SC&' cL Consistence r S Structure Mineralogy1 HORIZON III DEPTH Zai r S Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE 0. SITE CLASSIFICATION: V! LONG-TERM ACCEPTANCE RATE: REMARKS: P,�,�,�P ? LEGEND Landscape Position EVALUATION BY'<1­� 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)