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127 Brookmead Court Lot 17DAME COUNTY HEALTH DEPARTMENT » Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003552 Tax PIN/EH #: 5871-61-5955.17 TR Billed To: Tate Rice Homes, Inc. Subdivision Info: Meadows Edge Lot # 17 Reference Name: Location/Address: Brookwood Court -27006 Proposed Facility Residence Property Size: see map ATC Number: 4266 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 .190 wage Trea,Umnt and Disposal Systems). THIS AUTHORIZATION FOR WASTE R ON S V IWQA PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur Date: **NOTE** The issuance of this G has been installed in cc Disposal Systems," but iven period o e. L n- CERTIFICA_ TX. COMPLETION Ttificate ompletion shall indicate the system described on Improvement/Operation Permit mDk6qe with Article 11 of G. S. Chapter 130A, Section .1900 "Sewage Treatment and shill i,,N3 WAY be taken as a guarantee that the ystem will function satisfactorily for any �0 � y a� 10, W 40gS6 Environmental Health Specialist's Signature: DCHD 05/99 (Revised) TALK: SftAF lout/ * SCIZ1A L bi S -I R.. iE S•riaNDAP-fl Quicle— td COAM8ER. Date: B Z►4 Ola DAVIE COUNTY HEALTH DEPARTMENT �. Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990003552 Billed To: Tate Rice Homes, Inc. Reference Name: Proposed Facility Residence P"d /-6�00 Tax PIN/EH #: 5871-61-5955.17 TR Subdivision Info: Meadows Edge Lot # 17 Location/Address: Brookwood Court -27006 Property Size: see map ATC Number: 4266 **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 flOL, #People #Bedrooms #Baths 3 Dishwasher: 121"' Garbage Disposal: Q' Washing Machine: ❑'� Basement w/Plumbing: 000' Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0--74 AC412=5 Type Water Supply I Design Wastewater Flow (GPD) Site: New Repair ❑ System Specifications: Tank Size ru GAL. Pump Tank GAL. Trench Width Rock Depth !�1 Linear Ft. Other: �i �1�9-'�1 , Ar:1:3'r �1! Required Site Mad ifications/Cnnditinnc-- �PI` 10 L-1 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 # i3 (33Q251-8760 *�** . Environment THeajth Specialist's Signat� DCHD 05/99 (Revised) r r1 134.00' " 1 >8.00' Ref. IRS, o%s 5' C- U -)E CIN v Ij w see Io ,� S 89'44'36" E O • _'�_ 46.87' Z O IOo �I in O \u' H1 Gr 66 Sheet 2 of 2> �Ob Kv S �3 1� to Nth. NN 17 moo. 0 0.74 acres f /X\ 14rcr"J�Q9,<\ /X\ /X\ S 63. 23 ss-l�h 11 0.69 acr 1, Richard P. Bennett, certify that this plat was drawn ur supervision from an actual survey made under my supen No. 3176, recorded in Book as noted, Page , etc.) (other); that the a subdivision surveyed are clearly indicated as drawn from information ity that has an Pag` fat the ratio of precision as calculated cs% accordance with G.S. 47--30 as am gri e.4efter and seal.-o`•�'`•� ��i December d f �� - A -D- 3176 teal orq�6 L-31 6 • N I Q- `\ � f � S 23°0'03"E 224.36' CD m N CL m 0 Ln 0 m N 0 z C CO t ! I /m \fir t lo- \ t X84,08' R=50.00, W CHORD �524)Z. SS G 088'i (y 22005'48"W 74.52' R,258, �,�A_3a . oo D coir `N' \ ♦ ti MAP FOR Lo 1' , w D �� Al'N .l ENONIv"EPJJAL HEALTH l'SCOUP1TY N I:Oli SITE [VALUATION/IAII'I(UV[AI[NT i'G111111• & ll•I•C Davie County Health Department Ei1yironi»enta/Hes/t/i Section 1.0. Dox 848/210 Hospital Street Dlocksville, PTC 27028 (33G)751-8760 * * *I2'1PORTANT* * * THIS APPLICATION CANNOT DL PROCESSED UIILLSS ALL THL REQUIRL•'D IIIFOF1ATIOII IS PROVIDED. Refer to the INFORMATION 13ULLETIN for ilistLuctiorls. IF FOODSERVICE: It Seats Estimated Water Usage (gallons par day) _ __ B. Typo of water supply: M County/City ❑ Well ❑ Conuuunity 9. Do you anticipate additions or CXI)allsiolls of the facility this system is ill(ended to ser%,C'l 11 yes M No If yes, what ()'Ile? '**lAIPORTANT*** CLIEN'rS,1lUST conll'LLTG'rllE IU:'QUIRL•-D PROMRTY INFORMATION RLQ111;STI?I) 3ELO1V. Eithcr n PLAT or SITE PLAN MUSTBESUBMI'l-TrD by the dietll lrilh'1'111S �1I'I'LIC�\'PION. Pruperty Dilncll5iu115: '1':ll Office PIN: II See attached map WRITE DIRLCI•IOtNS (I`rom I\lucksl-ills) to I'It111'lil('I'1': 5871615955 East on Highway 153, turn right onto 1'rol)crly Address: Road Nallle Beauchamp Road City/Zip Advance, 27006 If in a SubdiY15i011 provide inl'urmalion, as follows: Name: Proposed Jade Associates Scctioll: Bloch: Lot: 17 Gun Club Road and proceed to the end of the road, turn left -onto Beauchamp Road and the site is located approximately tOo ni1es down Beaucharp Road on the right and left side of the road. 3/8/04 Datc home corners flagged: This is to certify that the information provided is correct to the best ol• illy luloll•ledge. I uaderstand that :illy l)erulil(s) issued hereafter arc subject to suspcnsioll or I'MCatioll, if (Ile site plans or intunded use cluulge, ur if (lie iufurula(ion Submitted ill this upplicatiou is f llsilied ur ch:mged. I, also, aulerstaul that I am respuusiblc fur till charges hicturrl/ frurn Ibis 1111plicatiull. I, hereby, gil•c conscut to the Authorized I1cpre5clllallyc oI tile Davie Cuuuly lle:llttl De`mrhl nl to enter upon above described pruperly located in Davic County )old uwmd by Jade Associ ates 1 I , tLC to cunduct ail testiq procedures as necessary to de(crllline (Ile site suitabilil)'. 3/15/04 DA'11 SIGNATURE I -t4'__ T111S AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the fullowhig: Existing and prupuscd property lines aid dimensions, structures, setbacks, and septic locations). SAC Revisit Charge llatc(s): Client Notificatiuu Date: ElIS: sigil given Arrnnnt Nn Jade Associates II, LLC Alan Jones 1, flame to be oillcd _ CouCact Pcr::un Post Office Box 4062 nailing Address vane 11huue __ __••_• Ilinston-Salm NC 27115-4062 (336) 759-9688 City/:,tate/'LIP ' 1)uJi11U:1.3 1'llul,e 2. llama on Permit/ATC if Different than Above Hailing Address City/SCaLe/Zip J. Application For: EX Site Evaluation ❑ Improvement Permit/ATC L1 11oL11 9. SyrLcm to Service: ® House ❑ I•Iol�ile Home ❑ Du:31I cC ,-s ❑ InduLtry ❑ OLlter -- _- S. Type system requested: (gi Conventional ❑ conventional modified ❑ innovaLiva G. If Residence: If People 4 11 13CCIroolli5 4 If Bathroullw 2.5 nDiol1waaher r_1Garbage Disposal K Plashing Machina 111JaIICltic 1L/flu Plumbing 7. If Dunincas/Industry /Other: verify type It People 11 Uilll:s 1l Commodes 0 Showers 11 Urinalu II WaLur Cooleru IF FOODSERVICE: It Seats Estimated Water Usage (gallons par day) _ __ B. Typo of water supply: M County/City ❑ Well ❑ Conuuunity 9. Do you anticipate additions or CXI)allsiolls of the facility this system is ill(ended to ser%,C'l 11 yes M No If yes, what ()'Ile? '**lAIPORTANT*** CLIEN'rS,1lUST conll'LLTG'rllE IU:'QUIRL•-D PROMRTY INFORMATION RLQ111;STI?I) 3ELO1V. Eithcr n PLAT or SITE PLAN MUSTBESUBMI'l-TrD by the dietll lrilh'1'111S �1I'I'LIC�\'PION. Pruperty Dilncll5iu115: '1':ll Office PIN: II See attached map WRITE DIRLCI•IOtNS (I`rom I\lucksl-ills) to I'It111'lil('I'1': 5871615955 East on Highway 153, turn right onto 1'rol)crly Address: Road Nallle Beauchamp Road City/Zip Advance, 27006 If in a SubdiY15i011 provide inl'urmalion, as follows: Name: Proposed Jade Associates Scctioll: Bloch: Lot: 17 Gun Club Road and proceed to the end of the road, turn left -onto Beauchamp Road and the site is located approximately tOo ni1es down Beaucharp Road on the right and left side of the road. 3/8/04 Datc home corners flagged: This is to certify that the information provided is correct to the best ol• illy luloll•ledge. I uaderstand that :illy l)erulil(s) issued hereafter arc subject to suspcnsioll or I'MCatioll, if (Ile site plans or intunded use cluulge, ur if (lie iufurula(ion Submitted ill this upplicatiou is f llsilied ur ch:mged. I, also, aulerstaul that I am respuusiblc fur till charges hicturrl/ frurn Ibis 1111plicatiull. I, hereby, gil•c conscut to the Authorized I1cpre5clllallyc oI tile Davie Cuuuly lle:llttl De`mrhl nl to enter upon above described pruperly located in Davic County )old uwmd by Jade Associ ates 1 I , tLC to cunduct ail testiq procedures as necessary to de(crllline (Ile site suitabilil)'. 3/15/04 DA'11 SIGNATURE I -t4'__ T111S AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the fullowhig: Existing and prupuscd property lines aid dimensions, structures, setbacks, and septic locations). SAC Revisit Charge llatc(s): Client Notificatiuu Date: ElIS: sigil given Arrnnnt Nn DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003105 Tax PIN/EH #: 5871-61-5955.17 Billed To: Jade Associates II, LLC Subdivision Info: Pro Jade Assoc. Lot # 17 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map Date Evaluated:�1 D f% Water Supply: Evaluation By: On -Site Well Community / Auger Boring Pit ✓ Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH n-10 Texture group C_ Consistence; S Structure Mineralogy1 HORIZON II DEPTH t Q ^ 3 2' Texture group S' CL +CL+_Salp Consistence f SS _ -'E ' Structure Mineralogy HORIZON III DEPTH 1113LA -SCS Texture group L. Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE o.. '"• .� SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: --01- C<' avCle— EVALUATION BY: 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 DCHD 05/99 (Revised) Account #: 990003552 Tax PIN/EH #: 5871-61-5955.17 TR Billed To: Tate Rice Homes, Inc. Subdivision Info: Meadows Edge Lot # 17 Reference Name: Location/Address: Brookwood Court -27006 Proposed Facility: Residence Property Size: see map Date Evaluated: