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186 Meadows Edge Drive Lot 15DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002436 Tax PIN/EH #: 5871-61-5955.15 DB Billed To: Darren Burke Constr. Subdivision Info: Meadows Edge Lot # 15 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility Residence Property Size: see map ATC Number: 3993 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 WASTEWA IS VA1,ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 1 5 - CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shal indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 o G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY t tak as a guarantee that the system will function satisfactorily for any given period of time. � / j�pnlc 1/Z/ / 7018 Septic System Installed By: Environmental Health Specialist's Signaturf: DCHD 05/99 (Revised) I I'l C) o�e QvtGc y srJ�5 GPAIA- tco Po -30s --Pch-j te- I�T;rz- y q Date: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' P. O. Boz 848/210 Hospital Street 3 , 3 -0 S Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002436 Tax PIN/EH M 5871-61-5955.15 DB Billed To: Darren Burke Constr. Subdivision Info: Meadows Edge Lot # 15 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility Residence Property Size: see map ATC Number: 3993 **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 I 1 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 "�1�� #People `A #Bedrooms `A #Baths :Z Dishwasher: Ef� Garbage Disposal: ❑ Washing Machine: E!r' Basement w/Plumbing: 21'- Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size O.cc� �' Type Water Supply Wastewater Flow (GPD) y Site: New Ig Repair ❑ System Specifications: Tank Size ICCOGAL. Pump Tank GAL. Trench Width7Z'�l Rock Depth 12' Linear Ft. Other: Required Site Modifications/Conditions: 0-1 ���.1iD �►"ti� I S''�r` EW c � � P�' Ca.h�-' 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 # is (336751-8760.**** y 1 Environmental Health DCHD 05/99 (Revised) Ac �_� /�F��L�� It -A J5— Feb 11 05 08:13a Darren Burke Construction 336-778-0436 Jun 10.03 11:I4a davle county envhealth 336 751 8786 P.2 APt'L,CMIGN fOlt SITE EVALUATION/IMP110VEAIENT 1•L:19531T.V ATC Davie County Health Department Fftw/wmwta/)&J&I seaioa P_o. aamc a4e/210 Hospital Street Nocksvilie, NC 29028 (336)751-8760 e•eIMPORTANr•e• THIS ApkLICATION CANNOT SE PROCESSED UNLESS ALL THE REQVIRED 31IFORDIATION IS PROVIDED. Refer to the INFORMATI O N BULLETIN for '7instruuctions. 1. Nana to be aillad QC.L- �u`r ,,•• >l� ntact 7etaon %[ �Y _,.,,,, nailias Addrela �+ Cx K ' .tt ^� Non. Phone • r0 [����yr / �J/{ Uti/scate/Zir - ��2-rNrbt tJLI `i � t..+ :2 7p/ �. u.3ime. FAone ------------ 2. hr—s on Pernit/MC it Vittoreut than Above Nalltny hddr... City/State/lay 1. Applio.tioa rot, ❑ Site ::valuation ❑ 1uprovament Permit/ATC oCh 4. syatme to aecviee: )KHouae 0 llobile moms ❑ Duaineso ❑ industry ❑ other S. Type ey.t= reque.ted. Y1 eoovention.l ❑ con—ttonal sodified D Innovative f. If aesidenee: a People f Bedrooms Y Datltioom5 _ '� '�-Sahvamber ❑oarb.g. DIPF—1 /Tdwaaltirg Raehine *.*hast/Plumbing 00asement/No Plu.bing 7. If sysi.eaa/Iadwtry /Other: verity _type a people a Sink. a cosodes a ;h—ra a urinal. a water Cooler. _ IF FOODSERVICE: # Seatu Hati:aated Hater Usage teallooe per day) _-, A. typo of water supply:�KCouaty/City ❑ Well Cl eoamnunIty 9- Do you anticipate additions or expansions or the facility Ihis system is intended to save! ❑ Yes �f�u If yes, what type? e141HPORTAN71•o r-UEW-'S MUST CDAIPLETETHE REQUIRED PROPERTY INFORMATION I2B.QIIFb'1'ED BELOW. Either a PLAT or SI FE PLAN MUSrSESUQM/TTE-D by the client with THIS APPLICATION. Properly Dimensions: • D xL 77 xaa30 WRITE DIRECTIONS (Irum filutlsritte) les YIt01'LlCrV. Tax office rw: n2 %!G� Property Address: Road?lamc i+dc�:ui> It jC' i�i FaLyC/I ur � JtL(� CityfZip ALC f:'Yf1lce- A1C- If fu a Subdivision provide informaion, aa!s follows: Name• S Gr-�� Section: Block- Lot: Is Date hasneeornrrsflagged: ' �'" t This is to certify that Use infor=dou provided Is correct to the best or my fewowicdge. 1 understand that any pennU(s) issued hereafter are subject to suspension or revocation, if the site plans or intended tuts change, or if the intonsuUon submitted in this application is fatsffird or changed. 1, also, aNdentandthat I am rrgrwniblejor aff charges incrermfhate (his appficatioa. f, hereby, give consent to fit(- Authorized Represeuta(ivc of file Davie Court Ifcaf(h Ucparbuuhl f to enter upon above described propertyJoa(ed in Divic County and oxvucd by to conduct all testing procedures as n„eessary to determine the site suitabi '( n DATE 2 V SIGrixri RE _ THIS AREA MAYBE USED FOR D(tAVVMG YOUR SITE PLAN (Include all of lite follovAug: Existing and proposed property Imes and ditpeosions, structures, setbacks, and septic locations). Site Revisit Charge Dalc(s): Client Plotifintion Date.. EAS: ? Sign given Account No.J T' Revised DCHD (85103 Invoice No. -qi(a S4 p.1 / U 1 m a ~ 1 a. C. 27 S?2jj)44.sj, Proposed layout for o Darren Burke Construction Company, Inc. Rot Lot 15 Meadows Edge l'a PB 8 Pg 143 'tlVIA 71 10.57' �0'Me ♦ s�°4j 494 41.1' 19.)9% \ --- --- 1317' ??87 X479 \ \ M Proposed I \ House o N Lot 16 r o 50.8• / � o H N �!i /• Lot 5 I CO r Oa 4000, Lot 14 DVE05100 Scale 1 inch = 30 feet DAVIE COUNTY HEALTH DEPARTMENT • . Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION 990002436 I6jffWdTf6Darren Burke Constr. PFFiff r um: %RNAF,q �f y: Residence PROPERTY INFORMATION Tr& 5871-61-5955.15 DB Meadows Edge Lot # 15 IL(�, Beauchamp Rd -27006 Wi 41%F e: see map Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence 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: LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscape Position EVALUATION BY: 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 ois 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) D�_ — -=--- ENJtRD V1v9ENTAL HEALTH DA`iIECOPUN 1' TION 1011 SITE CVALUATION/IAIP (OVUILNT PE-It1111T & ATC Davie County Health Department fiwiroi1i»enta/flea/t/l Section P.O. Dox 848/210 1105pital SLrccL Mocicsville, NC 27028 ` (336)751-8760 * * *ITIPORTANT * * * THIS APPLICATION CANNOT 1)E PROCESSED UNLLSS ALL TIM REQUIRED I11FOR14ATION IS PROVIDED. Refor to Lha INFORMATION DULLETIN for incl ucLiomi. 1. !lame to be Dillcd - COnL'aeL Pcrpon Mailing Address Post Office Box 4062 Ilo,ne Phone Clty/:,tate/'LIP llinston-Salem, PJC 27115-4062 (336) 759-9688 11LL:111)CUD Phuuc 2. llama on Permit/ATC if Different than Above Hailing Address City/Stale/Zip 3. Application For: 9 Site Evaluation g ❑ Improvement PerluiL/ATC L1 1JoLh 4. syctem to Service: ® House ❑ i•lobile home ❑ Dusinc:;a ❑ IndusL'ry ❑ OL:hLr-- ti S. Type system requested: M Conventional ❑ conventional modified ❑ innovaLivc G. If Residence. 11 People 4 11 Bedrooms, 4 II BaLllrocnl:: 2.5 bDiollwasher Garbage Disposal glWashing Machino M13a:lo:mnL/Plwnbing ❑DacwuenL/110 Plumbing 7. If Dusincss/Industry /OLhor: verify type I} l eoplc I! iiil:s _ _ p Commodes I! Showers ff Urinalu II WaLor C'oolcru IF FOODSERVICE: II ScaLD EDLinlaLed water UDagc (gallons par day) S. Typo of water supply: 16 County/CiL'y ❑ well ❑ Conuuunity�M 9. Do you anticipate addi tions or CXp1UlSiOIIS of the facility tIIIS S)'S(Clll is 1lltell(IC(1 tU SC1'vL'? ❑ Yes txV N1) If yes, what 0'pC2 ON. "**1A11'oltTiINT*** CLILN'rsaruSTConri'LL•rC'r)il 1U'QUIRL•'D PROM10-Y INFORMA-1-ION MQUI:s'rt:u I 13CLOW. Eldicr s PLAT or SITE PLAN AIUSTQCSUUAII77,CD by clic client will)'l'IIIS ,1l'PI,ICA'I'I I'roper(y Diulcusiulls; See attached map Warr*' waLC'1'I0PiS (I'ruul Alucl:sville) to I'R0I'I;ICI'1': Tax Office l'IN: II 5871615955 East on Highway 158, turn right onto Property Address: RoadManlc Beauchamp Road Gun Club Road and proceed to the end of City/Zip Advance, 27006 the road, turn left -onto Beauchamp Road If in a Subdivision provide fufurnlation, as 1`011=5: and the site is located approximately two Naluc: Proposed Jade Associates miles down Beaucharlp 'Road on the right and left side of the road. 3/8/04 Section: Bloch: Lot. 15 Date home corners flagged: This is to certify that (lie information provided is correct to the best of illy lulowledge. 1 understand that any pe1.lnil(s) issued llcreafter arc subject to SUSpCIISion O1' revocation, if (Ile site plans UI' ilitellded use Change, or if the i111*U1-111:Il1Ull sublui(tcd in (his application is falsified or changed. 1, also, undarstrulrl that1 run re3pullsible fur a// chulSgcs illclin-erl,%rorn this upplicutiulr. 1, hereby, give consent to (1)e Authorized Representative of (he l):lvic C(Jlul()' I10:11111 Du ):11.1111cu to cnta' upon above described pruperty located ill Davie Cuunly and unvncd by Jade Associ ates lu cunduct all testing procedures as necessary to de(crtniuc Ole site suitability. 3/15/04 DA'11 SICNATURE I �� TIES AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all Of (Ile fullowhig: Exisljllg and prupused property lines and dinlensions, structures, setbacks, and septic locations). e i Sign given N� Silc Revisit Charge llalc(s): Client Nolificatiun Date: x;z'zs: A1•rn11n1 Nn �� `. DAME COUNTY HEALTH DEPARTMENT '. Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003105 Tax PIN/EH #: 5871-61-5955.15 Billed To: Jade Associates II, LLC Subdivision Info: Pro Jade Assoc. Lot # 15 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see maP Date Evaluated: 3 Water Supply: Evaluation By: On -Site Well Community Auger Boring Pit Public Cut FACTORS A 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH © 31- D- 1 Texture group Consistence EW Structure r IC Mineralogy HORIZON Il DEPTH 1(0 Texture group.S Consistence ` 5S Structure Mineralogy HORIZON III DEPTH Texture group Consistence N Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE O •?� (,� SITE CLASSIFICATION: CJS EVALUATION BY: r LONG-TERM ACCEPTANCE RATE: Q�� 3� OTHER(S) PRESENT: t REMARKS: Q£�C 1� ,� 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)