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118 Meadow Creek Court Lot 29' CONSTRUCTION For office Use Only AUTHORIZATION *CDP File Number 195074-1 Davie County Health Department County ID Number: 210 Hospital Street Evaluated For: NEW P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 3/ 1 3/ a 0 a 0 Applicant: Reliant Homes Property Owner: Chris Merritt Address: PO Box 968 Address: 665 Croston Drive City: King City: Winston-Salem State2ip: NC 27021 State2ip: NC 27104 Phone #: (336) 757-6068 Phone #: Pronertv Location & Site Information Address/Road #: Subdivision: Meadows edge Phase: Lot: 29 118 Meadow Creek Court Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 158 right on Baltimore rd. Left on Beauchamp # of Bedrooms: 4 # of People: "Water Supply: PUBLIC psnn 1 nt Z Minimum Trench Depth: a 4 \ Inches Site CI8551fiCatIOR: Provisionally Suitable Saprolite System? QYes QNo Minimum Soil Cover. 1 a Inches Design Flow: 4 8 0 Maximum Trench Depth: a 4 Inches Soil Application Rate: 0 a 5 Maximum Soil Cover: 1 a Inches *System Classification/Description: *Distribution Type: PUMP TO GRAVITY TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP Septic Tank: 1 0 0 0 _ Gallons *Proposed System: 25% REDUCTION 1 -Piece: ®Yes QNo Pump Required: QYes QNo 0May Be Required Nitrification Field 1 9 2 0 Sq. ft. Pump Tank: 1 0 0 0 Gallons No. Drain Lines 1 -Piece: QYes QNo Total Trench Length: 4 8 0 ft GPM—vs— ft. TDH Trench Spacing: _ 9 Feet Oinches O.C. Dosing Volume: 0 0 _ Gallons Trench Width: 3 Qlnches _ Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -1 QTS -11 Septic Tank Installer Grade Level Required: QI 011 0111 01V psnn 1 nt Z COP File Number 195074-1 County ID Number. 0 Open Pump System Sheet Kepairbystem rcequireo:v r cayivuy�vu, uuc iras r%vanctuic vNduc ,'RePair System *Site Classification: Provisionally Suitable Design Flow: 4 8 0 Soil Application Rate: 0 - a 5 *System Classification/Description: TYPE III G. OTHER NON -CONY. TRENCH SYSTEMS *Proposed System: 50% REDUCTION Nitrification Field No. Drain Lines Total Trench Length: 1 9 a 0 Sq. ft. 6 Inches 0. $ e Feet O.C. a 4 0 ft. Trench Spacing:Q Inches 0. $ e Feet O.C. Trench Width: a QInches @ Feet Aggregate Depth: inches Minimum Trench Depth: a 4 Inches Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 a Inches Maximum Soil Cover: 1 a Inches "Distribution Type: PRESSURE MANIFOLD Pump Required: (Dyes ONo OMay Be Required Pre Treatment: O NSF OTS -1 OTS -11 *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this pennit bythe Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater System Construction shall bevalld for a person equal to the period of validity of the Improvement Perms not to exceed five years, and maybe issued at the same time the Improvement Permit issued (NCGS 130A-336(b)j If the installation has not been completed during the period of validity ofthe Construction Perritt, the Information submitted In the application fora permit or Construction Authorization Is found to have been Incorrect, falsified or changed, or the site Is altered, the permit or Constriction Authorization shall become invalid, and maybe suspended or revoked (.193T(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance, monitoring, reporting and repair (1938(b)). ApplicantlLegal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature: Date: _ / / *Issued By: 2140 -Nations, Robert Ne Date of Issue:. 0 3/ 1 3/ 2 0 1 5 Authorized State Agent: ae lop,..-� 4..- Malfunction Log OYes @Hand Drawing 01mport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CDP Fild Number 195074-1 Repair System *Site Classification: Provisionally Suitable Design Flow: 4 8 0 Soil Application Rate: 0 a 5 County ID Number. ❑ Open Pump System Sheet @Yes ONO ONO, but has Available Space "System Classification/Description: TYPE 111 G. OTHER NON-CONV. TRENCH SYSTEMS 'Proposed System: 50% REDUCTION Nitrification Field 1 9 a 0 Sq. ft. No. Drain twines 6 Total Trench Length: a 4 0 ft. Trench Spacing:Q Inches O.C. $ a Feet O.C. Trench Width: a • Inches _ Feet Aggregate Depth: inches Minimum Trench Depth: . a 4 Inches Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 a Inches Maximum Soil Cover: 1 a inches *Distribution Type: PRESSURE MANIFOLD Pump Required: Oyes ONo OMay Be Required Pre -Treatment: ONSF OTS -1 OTS -II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. "Permit Conditions The issuance of this permit bythe Health Department In no wayguarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater system Construction shall bevalyd for a person equal to the period of validity of the improvement Permit, not to exceed five years, and may be issued atthe sametime the ImprovementPermlt Issued (NCGS 130A -336(b)). If theinstaliation has not been completed during the period of validity ofthe Construction Permit, the Information submitted In theapplication fora permit or Construction Authorization Is found to have been Incorrect, falsified or changed, or the site Is altered, the permit or Construction Authorization shall become Invalid, and may besuspended or revoked (.1937(g)). The person owning or controlling the system shall be responsiblefor assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance, monitoring, reporting and repair (1930(b)). Applicant/Legal Reps. Signature Required? OYes ONO Applicant/Legal Reps. Signature: Date:. / "Issued By. 2140 - Nations, Robert Date of Issue:e,1 7/ 1 3/ 2 0 1 5 10_ . . Authorized State Agent: Malfunction Log OYes @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: County File Number: Date: 07/13/2015 Olnch Scale: OBlock O N/A 01 0 I� La � I( I i i or . . .. . ... .... � .... . . .... . ..... ........ I I i I I_ I-------- -- �98aLd � Si<� I D ISL I i ISI i I_. ill I I I �I Iii it El-FEEL=E! 01 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: P.O. Box 848 Mocksville NC 27028 County File Number: Date: .0.7 / 1 3/2015 Click below to Import an Image from an external location: Drawing Type: Construction Authorization IMPROVEMENT PERMIT d �6 Davie County Health Department 210 Hospital Street 'b .. P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 PERMIT VALID UNTIL: 7/13/2020 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be Issued with this Improvement Permit. Applicant: Reliant Homes Address: PO Box 968 CRY: King StatefZip: NC 27021 Phone #: (336) 757-6068 Address/Road #. 118 Meadow Creek Court Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC Property Owner: Chris Merritt Address: 665 Croston Drive CRY: Winston-Salem State/Zip: NC Phone #: 27104 Subdivision: Meadows edge Phase: Lot: 29 Provisionally Suitable Saprolite System? Oyes @No Design Flow: 4 8 0 Soil Application Rate: 0 2 5 u *System Classification/Description: *Proposed System: Directions Hwy 158 right on Baltimore rd. Left on Beauchamp Minimum Trench Depth: a 4 Inches Maximum Trench Depth: 2 4 Inches Septic Tank: 1 0 0 0 Gallons 1 -Piece: OYes @No Pump Required: @Yes ()No OMay Be Required Pump Tank: 1 0 0 0 Gallons 1 -Piece: OYes @No Repair System Required:@Yes ONO ONo, but has Available Space Repair System *Site Classification: Provisionally Suitable Soil Application Rate: 0 - 2 5 *System Classification/Description: TYPE III G. OTHER NON.CONV. TRENCH SYSTEMS *Proposed System: 50% REDUCTION Minimum Trench Depth: a 4 Inches Maximum Trench Depth: 3 a Inches Pump Required: @Yes O No O Maybe Required Pagel of 3 CDP File Number 195074 - 1 County ID Number: 'Site Modifications ❑ Open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. "Permit Conditions The issuance of this permit by the Health Department in noway guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Site Plan The Improvement Permit shall be valid for b years from date of Issue with a site pian (means a drawing not necessarily drawn to scale that shows the existing and proposed property lines with dimensions, the location of the facility and appurtenances, the 4► site forthe proposed Wastewater system, and the location of water supplies and surface waters). Plat The Improvement Permit shall be valid without expiration with plat (means a property surveyed prepared by a registered land surveyor, drawn to a scale of one Inch equals no more than So feet 'that Includes: the specific location of the proposed facility and appurtenances, the site for the proposed wastewater system, and the location of water supplies and surface waters. Plat also means, for subdivision lots approved by time local planning authority and recorded with the county register of deeds, a copy of the recorded subdivisions plat that Is accompanied by a site pian that is drawn to scale). The Department and Local Hearth Department may impose conditions on the issuance and may revoke the permits for failure of the system to satisfy the conditions, the rules, or this article This permit is subject to revocation if the site plan, plat; or intended use changes (NCGS 130A -335(f)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance, monnoring, reporting, and repair (.1838(b)). ApplicantlLegal Reps. Signature Required? Oyes ONo Applicant/Legal Reps. Signature: Date: / / *Issued By: 2140 -Nations, RobertOate of Issue: / 1 3 / a 0 1 5 /J F OValid without Expiration? Authorized State Agents. QCreate CA? @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Improvement Permit CDP File Number: 195074 -1 County File Number: Date: Q Inch Scale . QBlock QN/A 77-1 I II e� - - ..I j 5 d i�8 s -I io_ I I III I�I� i i i i -1- 7 IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: 195074 -1 County File Number: Date: .0 ,? / Ll -t31 / 2 0 1 5 Click below to Import an image from an external location: Drawing Type: Improvement Permit DocuSign Envelope ID: 9081EA2B-146F-4E3E-&ADC-32SD2E95C8C4 C jV�� APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC !! Davie County Environmental Health n �J P.O. Box 8481210 Hospital Street Modwilki NC Z= 910' !` (336)77u (336) 753-1680 ^.�Q �l Application For. �te vahutiorvlmptovemrnt permit Authorisation To Construct(ATC) moth Type of A—fiacion:. ew S— _ Repair to Existing System _ExpansioWNIodi&cation of Existing System or Facility s"IMPORTAN7*00 THIS APPLICATION CAN,VOT SE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to fthe INFORMATION BULLETIN far instructions. APPLICANT INFORMATION Name to be Billed Rtl n� - k i"e % LCC Contact Persat 13ren+ lJc. }ion Billing Address P r7 . Rae 4L 8 Home Phone City/State/ZIPx�*Ata- ?')0TI Business Phone '33f:'757 -000R Name on Pcrmil/ATC if Different than Above. Mailing Address — — NOTE: A survey plat or site plan must accompany this application. Included. = Site (Permit is valid for 60 months with site plan. no expiration with complete plat.) Owner's Name ;4t I G56 -ex Owner's Addres< 6kJJ Cr. - City/Smt&7 Property Address City Mir Lot Sized 7- Tax PINS"11 ta-114 ZI.T S 2- — Directions To :Plagto sale) Number 8 3 -2L7 -S1131 If the answer to any of the f)d*Wmg questions is -yes", supporoog documeaadon tuna be anacbed. Are there any existing wastewater systems on the W. _Yes _rNo Does the site contain jurisdictional wetlands?=Yes ., o Are there any easwmts or right -of --ways on the site? : Yes Is the site subject to approval by soother public agency? .:Yes _ o Will wastewater other than domestic sewage be generated? -'Yeso I # People ," - # Bedrooms# Bathrooms 3.5 Garden Tub(Whidpool CYes %:*o t — = I Basemen --Yes No Basement Plumb ✓fifes [.No IF NON -RESIDENCE FILL OUr THE BOX BELOW Type of Facility/Busiaess Total Square Footage of Building # People # Sinks # Comms # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type systemretluested: Nodonventional CAccepted .innovative _Alternative _Other ZSY0 Water Supply Type: ICounty!City Water - New Well '!Existing Well : Coaummity Well Do you anticipate additions or expansions of the facility this system is intended to serve? = Yes If yes, what type? ir"No This is to certify that the infomnation 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 attemd, the intended use cbanges, or i f the infatmation submitted in this application is falsified or tdrenged. I basby grant right of entry to the Authorized Representative of the Davie Cointy Health Depdomem to conduct necessary inspections to determine compliance with applicable laws and �es. I understand that f am responsible for the proper identification and labeling of ptuperty lines and goetters and Y loc r' WV staking the houWfWity location, proposed well location end the location of any other ammities. '` fpropectyY owner's or owner's legal representative sigtenue Site Revisit Charge Date(s): t0 Client Notifiadoa Date: Date EHS: Jqb074 o:........rw Vti ' Nn ACCOIn! iR 2Q 99Q4! 20 'tt'Lt S1P,8�t .0 1 — 23 1. Ll �, ti • a — z :,�.�' �� c�' �„ � �� 'Z•S �,, ........."`....-0�'s�� 53 49 L6 M C i 4b" L� 4th Q- y 1 L? zealr; 71 3�r . _��• Set L � W/bnni' .% yrg Nd pQDQ. r t� 411 L\ pump ouTU-1- - - Tb LINA SP!-�SFI �'+taX 1 30 at CC ," � —tet. ,i2,.r ,-^_ _c.��a�c�w �t•r�.�-t_C.o��C. 4 �. .��, ,� L�i� D�� � ZS c.- t � - . LO /,P. r nted:May 15, 2015 All data Is provided as is wtihaut wan arty Ar guarantee of any kind ei9ier expressed or im ed lnclu cng tiu2 not ami a the implied r arrantl of merchantability or fitness for a particular use. All users of Davie County's GIS webstte shall hold harmless the County of Davie, North Carolii Its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the use or Inability to use the GIS data provided by this website. Q I 2004 ENVIRONMENTAL HEALTH DA`!iE COUNTY 3 6eko-01%, 56e, 6 'ddra� ON 1:01i SITE EVALUATION/Ihll'IiOVLAIUtfI' I'llJIM1T & JVI'C Davie County Health Departniont ,Ei1Y fon1116J7 a/He,7&11 Section P.O. Box 848/210 Rospital Stzcct Mocksville, 11C 27028 (33G)751-0760 * * *1KPORTANT * * * THIS APPLICATION CANNOT DE PROCESSED WILLS" ALL 11'11L 1:LQUIIRLll I INFORIIATION IS PROVIDED. Refer to tho I14FORI4A'1'ION BULLETIN for incLl:uction.t. Jade Associates II, LLC Alar! Jones 1. ltamc to be billed Con Lac L' 1'crso:t _-__ � • Hailing Address Post Office Box 4062 1104110 1'liulle __.._•__••_. Clty/3tatc/'LIP llinston-Salem' PJC 27115-4062 Dusinu:rD 1'huuc (336) 759-9688 ___•.__,•_.__•_.• 2. Namo on Permit/ATC if Different than Above Hailing Addrean J. Application For. if Site Evaluation City/State/Zip ❑ Iinp>:ovelncnt Permit/ATC 0 )loth 4. system to Service: ® House ❑ 14obile Home ❑ BusincLs ❑ InduSL•ry ❑ Other— ti 5. Type system requeoted: M Conventional ❑ conventional modified ❑ innovative 6. If Residence: 11 People 4 11 Bedrooms 4 II BaL•Ilroom:. 2.5 tDiahwasher InGarbagc Disposal KiWashing Machine ❑Daseucnt/l lwnbinU ®Lat;awcnL/llo Plumbing 7. If Dusincas/Industry /OLltcr: verify type II !'eeplc II :iuls N CotnmodeD 0 Showers 11 Urinals II WaLor Coolury IF FOODSERVICE: I1 SeaL•a Estimated Water U::age (gallons per clay) 8. Type of water supply: (n County/City D well ❑ Couuuuraity 9. Do you anticipate additions or cxpallsialis of (lie facility this 53'stelli is iu(eudcd to serve? ❑ Yes iq Nu If ycs, what type? **Infl'OlfTil/YT*** CLIEN'PSiIIUSTCOA!!'.ccTE,r]IL 1(1sQU!!tL'U 1'Itol'L'lrrl hvl ol(n'lA'r10N uls�ulisri:u JELO1V. liitlicr n PLA"I' or Sll'E PLAN AIUSTBE- SUIlAtl77'!'U by the client iriUi'1'1115 r1 l'I'I,IC,1'I'ION. I'ruperty Dinlcusiuns: Tax Office 1'IN: it See attached map 5871615955 Property IddreeId Name Beauchamp Road Y X12 *0City/Zi1) Advance, 27006 If ill a Subdivisiolt provide ill fornlalioH, aS fUllOWS: N:litic: Proposed Jade. Associates Section: Bloch: Lot: 29 11'!tl'rli Ullt(iC'1'I01'qS (hula nluchsville) lu I'It(ll'I;It'1'1': 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 Wo iA1es down Beauchamp Road on the right and left side of the road. 3/8/04 Date tonic corners Ragged: This is to certify that (lie iufornmtion provided is correct to the best ol'►uy lutoWledge. I understand that any perniil(s) issued hereafter are subject to Suspension or rcvocatiou, if (lie si(c pl:uis or intended use ch:uige, or if the iuforuia(iun submitted in this application is falsified ur cliauged. I, also, tulderstand flint I ua1 rrsl,uns•ible fur all charges iucurrrll./Faut this application. I, hereby, gine conseut to the Authorized 11cpresenta(ive of the Davie Cuutt(y 11paldl De gNil cu to en(cr upon above described pruperly located in Davie County and wracd by Jade Associ ates to conduct all (es(ing procedures is necessary to de(eruiine the site suit 3/15/04 llA'1'L SIGNATURE 6 THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include :ill of lite fulluWing: Existing :u1d proposed property lines and dinlensious, structures, setbacks, and septic locations). Sign giver] Site Revisit Charge Datc(s): Client Notification Date: EIIS: .t , ...., Nf" ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVJSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003105 Tax PIN/EH #: 5871-61-5955.29 Billed To: Jade Associates II, LLC Subdivision Info: Pro Jade Assoc. Lot # 29 Reference Name: Location/Address: Beauchamp Rd -270P6 Proposed Facility: Residence Property Size: see map Date Evaluated: 0Z Water Supply: Evaluation By On -Site Well Auger Boring Community_ Pit f Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position r— Slope % 76 HORIZON I DEPTH en r Texture group C Consistence i (—' Structure 1L MineralogyE 1 HORIZON 11 DEPTH i Texture grou C4 Consistence ` Structure Mineralogy< 1 HORIZON III DEPTH 3 Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group W4TITL Consistence ► N Structure ( i Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE & SITE CLASSIFICATION: r 6 / LONG-TERM ACCEPTANCE RATE: REMARKS: Landscape Position EVALUATION BY: -r,� N OTHER(S) PRESENT: D4fit.Jt Afy �jt_©'f LEGEND t rov-11V &Q10 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) This map or drawing and any accompanying documents ore furnished to the person(s) named thereon and no alterations or use by others is permitted unless authorized by Allied Land Surveying, P.A. Certified copies of this survey map will not be issued beyond ninety (90) days of the original survey date. Map not for recordation_ Precision 1:10,000+ EP --- -- -- - ...��.......-.._.._._..._.... _._.._ ..-- R/W IRS1�gs %"184.4 S88'51'56"E 69 9U7.8 O298J 0 U11UTY /)647 1 P29 / 29A O 1 30� 0 / O41,045'sq. t. 30,99�sq. ft. 8694 acres - 77 0. Q acres /�q. fi_30B 'u, / C6cres�Np v �� 7 30 JO i�r1 O TP31Ai orO 64.8 167.0 O- ± O TP316 r 921 _)N 35,11 sq. ft., 0.81 1 acres[ — EARL F. MYERS _ n DB 112, PG 438 6���` °' -- 'IN: 5871421343, LOT 1343--- 34 ZONED: R-20 1 /` " — — — 33 N 32,2 / 3231.54 4 sq `ft 4� f X74 a r 1,431 sq. ft. 0,72 acres O TP34E 0.72 acres �t� 33A O ti TP0 s O 036 DEED DISTANCE FF "TIE LINE"----�' T—BAR 0 CALCULATE[ S89'14'57"E 429.00' 7-s 4 S89 27'00"E RS 88'32'17"E--- 177-5.72` �TO A 7�--7 (TIE LINE FROM T -BAR TO 1.5 BAND' PASSING A FENCE PST ON LINE AT 1343.72') Davie County, NC Tax Parcel Report Wednesday, February 15, 2017 Alldata Is provided as Is without warranty or guarantee of any kind either expressed or Implied including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the NC County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to �'p �q or arising out of the use or Inability to use the GIS data provided by this website. WARNING: THIS IS NOT A SURVEY Parcel Information BEAUCI-IAMP RD BEAUCHAr0P RD Parcel Number: 2111�� Township: Farmington NCPIN Number: 5871426552 124 118 ti 108 �t 'ti �4 107 Census Tract: 37059-803 Listed Owner 1: MERRITT CHRISTOPHER Voting Precinct: MEADOW i rv1EADOW CREEK CT BROOK CT Planning Jurisdiction: Davie County 125 ADVANCE �. i Alldata Is provided as Is without warranty or guarantee of any kind either expressed or Implied including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the NC County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to �'p �q or arising out of the use or Inability to use the GIS data provided by this website. WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: E816OA0029 Township: Farmington NCPIN Number: 5871426552 Municipality: Account Number: 8305211 Census Tract: 37059-803 Listed Owner 1: MERRITT CHRISTOPHER Voting Precinct: SMITH GROVE Mailing Address 1: 118 MEADOW CREEK COURT Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27006-7579 Voluntary Ag. District: No Legal Description: LOT 29 MEADOWS EDGE PHASE 2 Fire Response District: ADVANCE Assessed Acreage: 0.68 Elementary School Zone: SHADY GROVE Deed Date: 7/2015 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 009930785 Soil Types: GnC2 Plat Book: 0008 Flood Zone: Plat Page: 259 Watershed Overlay: DAVIE COUNTY Building Value: 231360.00 Outbuilding & Extra Freatures Value: 4320.00 Land Value: 42500.00 Total Market Value: 278180.00 Total Assessed Value: 278180.00 Alldata Is provided as Is without warranty or guarantee of any kind either expressed or Implied including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the NC County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to �'p �q or arising out of the use or Inability to use the GIS data provided by this website. OPERATION PERMIT Davie County Health Department r. 210 Hospital Street P.O. Box $48 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Reliant Homes Address: PO Box 968 Cay: King State/Zip: NC 27021 Phone #: (336) 757-6068 "CDP File Number 195074-1 County ID Number. Evaluated For NEW Township: /"Property Owner: Chris Merritt Address: 665 Croston Drive City: Winston-Salem State2ip: NC Phone #: 27104 c Property Location & Site Information Address/Road #: Subdivision: Meadows edge Phase: Lot: 29 118 Meadow Creek Court Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC *IP Issued by. 2140 -Nations, Robed *CA issued by: 2140 - Nations, Robert Design Flow: 4 8 0 Soil Application Rate: 0 a 5 Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: Directions Hwy 158 right on Baltimore rd. Left on Beauchamp *System Classification/Description: TYPE III B. SYSTEM w/SINGLE EFFLUENT PUMP Seprolite System? QYes QNo *Distribution Type: PUMP TO GRAVITY Pump Required? QYes QNo *Pre Treatment: Drain field 1 7 4 6 Sq. ft. 9 5 8 2 fl. 9 Inches O.C. Feet O.C. 3Inches ()Feet inches Minimum Trench Depth: a 4 Minimum Soil Cover. 1 2 Maximum Trench Depth: a 4 Maximum Soil Cover: 1 a *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Frank Transou Certification #: 2711 'EH S: 2140 - Nations, Robert Date: 0.2/ 0 9/-1 0 1 6 CDP File Number 195074-1 Manufacturer. Shoaf STB: 347 Gallons: 1000 County ID Number: Lat. Long: Installer: Frank transou Date: 07/ 0 4/ a 5 / a 0 1 5 Certification #: 2711 ❑ No RiserHeight: B Yes ❑ *EH S: 2140 - Nations, Robert *Filter Brand: POLYLOKPL-122 With Pipe Adapter El ST Marker: E] Yes 2 No Date: 0 a/ 0 9/ a 0 1 6 nforced Tank: ❑ Yes ® No ❑ Approval Status Vent Hole Q Yes ❑ No Anti -siphon Hole "® Approved ❑ Disapproved 1 Piece Tank: ®Yes NO El No Pump Tank Manufacturer. shoal PT: 363 Gallons: 1250 Date: 0 5/ 0 4/ a 0 1 5 RiserSealed S Yes ❑ No RiserHeight: B Yes ❑ No (Min.6 in.) nforced Tank: ❑ Yes El No 1 Piece Tank: [E Yes ❑ No Pipe Size: a inch diameter Pipe Length: 1 4 0 feet *Schedule: 40 Installer. Frank Transou Certification #: 2771 *EH S: 2140- Nations, Robert Date: 0 a/ 0 9/ a 0 1 6 Pressure Rated Yes ❑ No Date: 0 a/ 1 0/ a 0 1 6 Approved fittings ® Yes ❑ NO Approval Status Approved ❑ Disapproved Pump Type: Zoeler Installer. Frank Transou Dosing Volume: — Gal Certification #: Frank transou Draw Down: Inches *Chain: STAINLESS Valves Accessible p Yes ❑ No Flow Adjustment Valve O Yes ❑ N o Check -valve El Yes ❑ NO PVC Unions 0 Yes ❑ No Vent Hole Q Yes ❑ No Anti -siphon Hole 0 Yes 0 NO *EH S: 2140 - Nations, Robert Date: 0 a / 1 0/ a 0 1 6 Approval Status; FOR Approved ❑ Disapproved CDP File Number 195074 - 1 N EMA 4X Box or Equivalent [] Yes Box 12 inches Above Grade Q Yes Box Adj. To Pump Tank Q Yes Conduit Sealed O Yes Pump Manually Operable p Yes *Activation Method: PIGGYBACK No Alarm Audible ® Yes Alarm Visible ® Yes County ID Number: Electric EQUinment ❑ No Installer: Frank Transou ❑ No Certification #: 2771 ❑ No ❑ No *EH S: 2140 - Nations. Robert ❑ No Date: 0 2/ 1 0/ 2 0 1 6 1:1 N 0 Approval Status Approved O Disapproved ❑ No 2140 - Nations. Robert *Operation Permit completed by: Authorized State Age , .��"�..` Date of Issue: 0 2 / 1 0 / 2 0 1 6 Owner/Applicant Signature: This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 18A .1900 et. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE 111 13. sewage septic system. Rule .1961 requires that a Type TYPE III B. septic system meet the following criteria: Minimum System Review By The Local Health Department: SYRS. Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator: NIA Reporting Frequency By Certified Operator: NIA Rule .1961 requires that a Type IV and V septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the life of the septic system. Rule .1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit fora system required to be maintained by a public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Dr ` OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: 195074 -1 County File Number: Date: 0;l/ 10 /-1016 Q Inch Scale- 0131ock = ft CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 195074 - 1 ' Davie Count Health Department Y P County ID Number: .' . 210 Hospital Street Evaluated For: NEW •�,�• P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 7 / 1 3/ a 0 a 0 Applicant: Reliant Homes Property Owner: Chris Merritt Address: PO Box 968 Address: 665 Croston Drive City: King City: Winston-Salem State/Zip: NC 27021 State/Zip: NC 27104 Phone #: (336) 757-6068 Phone #: i Address/Road #: 118 Meadow Creek Court Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC Subdivision: Meadows edge Phase: Lot: 29 Directions Hwy 158 right on Baltimore rd. Left on Beauchamp ns /Site Classification: Provisionally suitable Minimum Trench Depth: a 4 Inches \Si Saprolite System? O Yes (? No Minimum Soil Cover: 1 a Inches Design Flow: 4 8 0 Maximum Trench Depth: a 4 Inches Soil Application Rate: 0 .22 5 Maximum Soil Cover: 1 a Inches *System Classification/Description: *Distribution Type: PUMP TO GRAVITY TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP Septic Tank: 1 0 0 0 Gallons *Proposed System: 25% REDUCTION 1 -Piece: ® Yes O No Pump Required: ® Yes O No O May Be Required Nitrification Field 1 9 a 0 Sq. ft. Pump Tank: 1 0 0 0 Gallons No. Drain Lines 1 -Piece: ®Yes ONo Total Trench Length: 4 8 0 GPM --vs-- ft. TDH ft Trench Spacing:—Inches g O.C. Feet O.C. Dosing Volume: 0 0 _ Gallons Trench Width: 3 Olnches ® Feet _ Grease Trap: Gallons Aggregate Depth: inches Pre -Treatment: O NSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01 011 0111 01V / Page 1 of 3 CDP File Number 195074 - 1 County ID Number: ❑ Open Pump System Sheet Repair System Required: 0 Yes ONO ONO, but has Available Space Repair System *Site Classification: Provisionally suitable Trench Spacing: 8 O Inches O. — (9 Feet O.C. Trench Width: O Inches Design Flow: 4 8 0 _ a ® Feet Aggregate Depth: Soil Application Rate: 0 a 5 inches *System Classification/Description: Minimum Trench Depth: a 4 Inches TYPE III G. OTHER NON -CONY. TRENCH SYSTEMS Minimum Soil Cover: 1 a Inches *Proposed System: 50% REDUCTION Nitrification Field 1 9 a 0 Sq. ft. No. Drain Lines 6 Total Trench Length: a 4 0 ft. Maximum Trench Depth: 3 a Inches Maximum Soil Cover: 1 a Inches *Distribution Type: PRESSURE MANIFOLD Pump Required: (&Yes O No O May Be Required Pre -Treatment: O NSF OTS -I OTS -II *Site Modifications de No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. R Remaining 750 *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Characters Remaining 2000 This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not to exceed five years, and may be issued at the same time the Improvement Permit issued (NCGS 130A -336(b)). If the installation has not been completed during the period of validity of the Construction Permit, the information submitted In the application for a permit or Construction Authorization is found to have been incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall become invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance, monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? O Yes ONO Applicant/Legal Reps. Signature: Date: / / *Issued By: 2140 - Nations, Robert Date of Issue: 0 7 / 1 3 / a 0 1 5 010L Authorized State Agent: � Malfunction Log Oyes Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 1,x.3 210 Hospital Street '; CDP File Number: Box 848 P.O.P. ksvx NC 7 270281 Cou ty File Number: —1 e / Date: A7./ .1.3. � .a. 0.1.5. Click below to import animage from an external location: Drawing Type: Construction Authorization C, t.4 s k -j G r� �J Page 3 of 3 to(. -o cc, rt,! - P1 P2