Loading...
167 Meadows Edge Drive Lot 8_ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001597 Tax PIN/EH #: 5871-61-5955.08 MB Billed To: Marquis Building Subdivision Info: Meadows Edge Lot # 08 Reference Name: Location/Address: Meadows Edge Dr. -27006 Proposed Facility Residence Property Sizer see map ATC Number: 4046 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 Trea t and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA N IS V ID F PERIOD OF FIVE YEARS. ,t Environmental Health Specialist's Signature: Date: o 9S . CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the has been installed in compliance with Article 11 /guar Disposal Systems," but shall in NO WAY be tak69 given period of time. 40A, Section T900 that the system will �L( � t r5' 1 Septic System Installed By: Environmental Health Specialist's Signature : DCHD 05/99 (Revised) 1-�Uf� CZC-AA- QkAUL 4 srt Date: 1Z Z O K Permit for any DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 �� -,� �_ cfl -5- (336)751-8760 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001597 Tax PIN/EH #: 5871-61-5955.08 MB Billed To: Marquis Building Subdivision Info: Meadows Edge Lot # 08 Reference Name: Location/Address: Meadows Edge Dr. -27006 Proposed Facility Residence Property Size: see map ATC Number: 4046 **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 &gs-, #People #Bedrooms y #Baths �Z- S Dishwasher: 0"' Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 104 AC.24:-S Type Water Supply C-esJTyDesign Wastewater Flow (GPD) t40 Site: New 0*� Repair ❑ System Specifications: Tank Size IDMGAL. Pump Tank ICM GAL. Trench Width 3u Rock Depth --1— Linear Ft. Hoo Ccs~ Other: 1��� 1 e tJ�4'Ei Sji'sT^� �t fsT w�� '1��� �c��JlTi o•.1 2c QTS Required Site Modifications/Conditions: � ��t � L. %�=Q � � F �.i-�-'� VJa=P IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department or final inspection of this system between 8:3 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # s (336)751-8760.**** •��!� � 2 AQP � Imp Al? Ll so, E Environmental Healt Specialist's Signature: DCHD 05/99 (Revised) FSS F4 *Fc- Mia IO' 2S' D 4 � �a N�,r I i s�1J' r *Fc -t -) Lt,tn> trl C�� T Date: npr 10 05 03:44p Gordon Whitney 336 940-6947 p.2 APPUCATION FOR SIT[ EVAMI MY/IMPROYEMINf PERIUT & ATC Davie County Health Department Environmental /lealth Section P.O. Box eke/210 Hospital st=et Mocksville, NC 27028 (330751-060 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATIONIS PROVIDED. Re£er to the.IN80RMATION BULLETIN for instructions. 1. Name to tae Billed Ijt�ln-QQV15 \t Oii�C .�4'1-1C'. Contact Person /��, Nailing Address Y/I.�l fi, !�r-j.. 11 Home Phone q4t. -6 int A 7 L city/state/ZIP A,"AuLE _ t5c zneotn Business Phone 341j - 3iSg 2. Name on Pernit/ARC if Different than Above Nailing Address city/statelaip 3. Application For: 0 Site Evaluation K Improvement Permit/ATC I'1 Both a: system -to Sezvice: � House U Mobile Hone 0 Business f} Industry 11 Other _ 5. If Residence: R People M Bedrooms 4 R Bathrooms -Lit 2- 1%Disbasbas 1:1 Garbage. Aispoaal �'nashiaq Machine 11 Basemeet/Plwebing � Baseeent/No rlusbipg 6. Zf Business/industry/Other: Specify type R People R sinks I'ebmaoder 0 s'hoxers R Urinals t Yater coolers IF FOODSERVICE: 6 Seats Estimated Water Usage (gallons per day) 7. Type of water supply: YL County/City n well O community e. Do you anticipate additions or expansions of the facility this system is intended to serve? A Yes XNo If yes, what type? • *IMPORTANT' CLIENTSMUSTCOMPLETETHE REQU/REDPROPERW INFORMATfONREQUES-MD BELOW. Either a PLAT or SITE PLAN MUST Br• SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 166 ,, Z 51 Y, z4 2.7, Yk Z P WRITE DIRECTIONS (from Moeksville) to PROPERTY: Tac Office PIN: N 5' O / I — 1* / ­51 Property Address: Road Name (IeA%.f City/zip / til�ff�ti[ is 27 (o y, If in a Subdivision provide information, as follows: Name: J%\e1N 1J5 V (iCrE Suction: Block: Lal: 42 ) Date Properly Flagged: / 6 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 Sile plans or intended use change, or if the information submitted in this application is falsified or changed. I; also, understand that I ani respomihle jar all charges incurred jra#n This application. [.hereby, give consent to the Authorized Representative of the Davie County health Department to enter upon above described property located in Davie County and awned by to conduct all testing proccdmres as necessary to determine the site suitabi DATE b { it l nh SIGNATURE dCs+. t THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLATY (Include all of the following: Ezis . g and proposed properly lints and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: EHS• Account No. Revised DCIiD (07199) � Invoice No. EJ s#,T J l`� e- Iii '17 . R jr 10 05 03:44p 2(0 Gordon Whitney 336 940-6947 p.3 46A -L -E 0 GD&t a.-mL'0 1"=: do' S89'43'48"E 694.34' 50' 243.23' W w. LO C; �o res t o N 1.04 acres f N Z Z 50' i 0.77 acres 20' Public Drainage Easement —.102..5.0 _ 77.92' CH 1- 8 10' Utility Easement Control N 81'44'4 6��6' Cy Iblic 50' R/W), 27' BC --BC Corner W R� 28 S 89'44'36" E CD ' 10' Utility Easement U f 146.87' 16 0.75 acres f - - -. - -0- -„ - N LO 0 M 3 A SAF - �03 � •29, . cy . 0O 15 N N 0.69 acres f r6 42r v� a5, A-71 LU I M � I CO �c I LO w LO•N 0;0 N N I W to C) N �• LO W o l .— 16 0.75 acres f - - -. - -0- -„ - N LO 0 M 3 A SAF - �03 � •29, . cy . 0O 15 N N 0.69 acres f r6 42r v� a5, A-71 rg E APPLICATION 1011 SITEEVALUATION/IAll'IIUVEAl1Nf 1'11.10111& 11'1'C 2004 Davie County Health Department Ei1Yir011111enta/He,7&11 SectiOil P.O. Dox 848/21.0 Hospital SLrcct VIFONIE�gLHEALV Mocksville, VC 27020 ppVlE COU'd1Y (3 3 G) 7 51- i 7 G 0 * * *XHPORTA.NT * * * THIS APPLICATION CANNOT DE PROCESSED UNLESS ALL THE I:L•'QUIRLD I I1IFOR11ATION IS PROVIDED. Refor to the INFORMATION DULLETIN for insLrucLiorl:r. 1. Name to be Billed Mailing Address Ci Ly/S tate/'LIP Jade Associates II, LLC Post Office Box 4062 Winston-Salem, PJC 27115-4062 Alar! Jones Con Lacl !'croon home 1'llullo lluuineas l lrulrc ( 336) 759-9688 2. Ramo on Permit/ATC if Different than Above Mailing Address City/StaLc/Zip J. Application For: if Site Evaluation ❑ IlnprovemcnL Permit/ATC ❑ 11uL'h a. system to Service: ® House ❑ 1101,ile Home ❑ Du:;illcL's ❑ I11du:;L•2:y ❑ OLlrcl: -- -- ti 5. Type system requested: IZ] Conventional ❑ conventional modified ❑ innovaLive 6. If Residence: II People 4 Il Dedrooms 4 II DaL'llrOpllw 2.5 tDinhwasher InGarbagc Disposal nNashing Machine ❑Basement/PlwWUing K1IJa;;cmcnL/llo Plumbing 7. If Dusincss/Industry /OLhor: verify type 11 People 11 :;ill)-:; N Commodes I) Showcra 11 Urinalo 11 WaLar Cooleru IF FOODSERVICE: It Seats Estimated Plater U:;age (gallons per day) 8. Typo of water supply: In County/CiL'y ❑ Etch ❑ ConununiLlr 9. Do you anticipate additions or C%pall5i0llS of lI1C f;lCilily this SyS(Clll is Ill(L'llllcll to Se1'11L''/ ❑ yes No If yes, 11 -hat type? '**1A1110RTAjYT*** CLIENTS MUST C0H1'LL7L'rIIL IULQUIRL'D PROl'LWIT INFORMATION REQUESTED 3CLO1V. Either a PLAT orS1TE PLAN HUSTBESURM17TED by the client n•itll'1111S APPLICATION. !'roper(. Dimensions: Tax Office 1'1N: 11 See attached map 5871615955 lrroperty Address: Road Nalllc Beauchamp Road City/"Lip Advance, 27006 If ill a Subdivision protide infurnlation, as follows: Nalllc: Proposed Jade Associates Section: Bloch: Lot: 8 WRITE* DIRECTIONS (from 111uclw-illc) lu East on Highway 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 fai 1 es dorm Beauchamp 'Road on the right and left side of the road. 3/8/04 Datc Monis corners ll;egged: This is to certify that the hiformation provided is correct to the best ol'uly lulolvledge. 1 understand that ally perinil(s) issued hereafter arc subject (o suspcusion or revocation, if the site plalls ur ill(clided Ilse clnulge, ur if the iul,urula(iull subtllillcd ill this applica(ioll is falsified ur changed. 1, also, « tldcrstaiul Neat 1 «Ill rc3puusible fur fill Charges incllrrrrl /runt this application. I, hereby, givc collSCl1I to (tic Authorized 11Cprc5cll(at1Ve of (lie Davis CuuMly 11calth Dclmr(u cnl (o cu(cr upon above described prupert), lucated ill Davie Cuunly and u11'llcd by Jade Associates 41 , LLQ to cuoduct all testillg procedures as necessary to determine the silt suitability. - 3/15/04 DATE SIGNATURE, _ T1I1S AREA MAYBE, USED FOR DRAIYING YOUR SITE PLAN (Include all of (lie fullmillg: Existing :old prupusell property (ides and dinleusials, structures, setbacks, and septic locatiuns). Site Revisit Charge Date(s): Client Nolification Date: Elis: Sign given A'.,.,, .... t TV,. . 0 / v 5- DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990003105 Billed To: Jade Associates II, LLC Reference Name: Proposed Facility: Rsidence Property Size Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5871-61-5955.08 Subdivision Info: Prop. Jade Assoc. Lot # 08 Location/Address: Beauchamp Rd -27006 see map Date Evaluated: (S 6t'� Community. Public Evaluation By: Auger Boring Pit Cut n�G SITE CLASSIFICATIONS LONG-TERM ACCEPTANCE RATE: REMARKS: b u (lrf_J� 10&. . LEGEND Landscaae Position EVALUATION BY: OTHER(S) PRESENT: _ Z .117,1 � °7y14- 96 V 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 �o�stn�ti 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) HORIZON I DEPTH MUM Consistence HORIZON II DEPTH Consisten- rmmEMEMKMMIMI HORIZON III DEPTH - Mineralogy HORIZON IV DEPTH Texturegroup Consistence �■������ SOIL WETNESS SAPROLITE CLASSIFICATION SITE CLASSIFICATIONS LONG-TERM ACCEPTANCE RATE: REMARKS: b u (lrf_J� 10&. . LEGEND Landscaae Position EVALUATION BY: OTHER(S) PRESENT: _ Z .117,1 � °7y14- 96 V 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 �o�stn�ti 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)