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122 Meadows Edge Drive Lot 24DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002436 Tax PIN/EH #: 5871-61-5455.24 DB Billed To: Darren Burke Constr. Subdivision Info: Meadows Edge Lot # 24 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility Residence Property Size: see map ATC Number: 4010 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, Sectio a Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE.CTI, IS VMD FOtR,Ei PERIOD OF FIVE YEARS. Environmental Health Specialist's CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit ?� has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any Z_ I given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 10 SPLA& t� GAK Pifi<: 1.3cyr NcicY.,-Li� 6PG� /I- r f7� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT 5 _9 I,/ 5871-61-54 Meadows Edge Lot # 24 Beauchamp Rd -27006 ,_ V o s Account #: 990002436 N"In 1014( Tax PIN/EH #: Billed To: Darren Burke Constr.Ct KUd Subdivision Info: Reference Name: 10 ,D5 Location/Address: Proposed Facility Residence Property Size: ATC Number: 4010 see map **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 f, t #People L1 #Bedrooms y #Baths 2.S Dishwasher: Garbage Disposal: ❑ Washing Machine: ET'� Basement w/Plumbing: 171" Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size O• `1'2A-� Type Water Supply L-00TY Design Wastewater Flow (GPD) 145 Site: New 00' Repair ❑ System Specifications: Tank Size 00 GAL. Pump TanklC00 GAL. Trench Width 31--' Rock Depthr� & Linear Ft. 345 , Other:`i UIc�IL/a!7U16a`I�(L'S, `1-i: Required Site Modifications/Conditions: '?�=LL 1j 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 (336)751-8760.**** Z --I >-.- - —.An 1 a 10" 7e Z,z'rerA,V, rNi l- I :5R -&M% Zs Ll ►)e�N 75' �� 1 �1 240`�a� �Za wto LI i Environmental Health Specialist's Signature:c--4m! Date: � Os'��ti DCHD 05/99 (Revised) 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 990002436 Tax PIN/EH #: 5871-61-5455.24 DB Billed To: Darren Burke Constr. Subdivision Info: Meadows Edge Lot # 24 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility Residence Property Size: see map ATC Number: 4010 **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 . 0ot)&47- #People L— #Bedrooms L4 #Baths Z - S Dishwasher: Q'� Garbage Disposal: ❑ Washing Machine: Er— Basement w/Plumbing: Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0-72- Ate= Type Water Supply &1 -SW Design Wastewater Flow (GPD) 4?Q Site: New Er Repair ❑ System Specifications: Tank Size 1000GAL. Pump Tank GAL. Trench Width St; Rock Depth 12- Linear Ft.�.p Other: `7 11Si fZt�Xtc �,3 Required Site Modifications/Conditions: 1*—�T�-t� of ��ie� �'Q 1� �C'F ►Sc" Yu cF t,/.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 # is (336)751-8760.**** V . Mac ii -ll 1�-1 2g' N _ ri (70Q d Environmental Health Specialist's Signature: DCHD 05/99 (Revised) i ��{ &0(4 LP>]t Date: W Mar 09 05 08:50a Darren Burke Construction 336-778-0436 p.2 Mar 04 05 12:24p p.1 EL=97.8' EL=99.3' BWA of S SV4,tlW£` 125.00' / \ l 10' Uav Easer6w �-- _.—.—._-- I --•-----%` ``� Rekn<Eleva, tWofEltatlotcaper \ `EL=95.1 ELA5at \ \ \ \ EL= .6 \ \ ` a=93 5' \ \ \ of \ \ \ N SB'3723' W t25,02' Lot 24 Meadows Edge Stale 1 inch = 30 feet U 92.23' 143.00" CH---- `+.uu f 10' Util 81.58+ 4" W -Control Corner 39 R-7 0.00 ti �, 45.12' 45'S — Public Drainage Easement 0 -o 143_00' Easement — Me, N 89044'36" W 10' U tilitEosement 125.00' 125.00' S 67.61' 125.02' 1 /2" EI R N88 -3:T23 w (1 /2" El TO !o PP 30.64' S 39"15'50" W 105.73' 298.36' 3/4' 3/4" EIP) PATSY CARTER KIGER BYERLY ` \ DB 482, PG 647 a ` PIN: 5871529065, LOT 9065 \ 23 �� n PP � ` IjN CO/ 6� •g6 -� I ,, 56 E , t c O N ")io 24 23 � �N rCNto 0.72 acres f o 0 N 0.72 acres f N S 67.61' 125.02' 1 /2" EI R N88 -3:T23 w (1 /2" El TO !o PP 30.64' S 39"15'50" W 105.73' 298.36' 3/4' 3/4" EIP) PATSY CARTER KIGER BYERLY ` \ DB 482, PG 647 a ` PIN: 5871529065, LOT 9065 \ 23 �� n PP � ` IjN CO/ 6� •g6 -� I ,, 56 E , t c Mar 02 05 00:21a Darren Burke Construction 33G -770-043G p,1 Jun 10 03 11:14a davie county envhealth 336 751 8786 p.2 APPUMION FUlt blit iVALtAT1ON/IMPIZOVEAIENT PLlWI 15 MC Davie County stealth Depanment EnrirvnMww1Aw1t t.ScAd ov P_O_ Boat 848/210 roapital Street Xaeksville, N,- 27028 (336)7SI-6760 •+*nfPORTANT-** 'J'HIS APPLICATION CAbWT BS PROCESSED ONLESS ALL THE REQUIXW XUFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for iinatructiono. 1. Nose to be 8111.4ZJQ/ 'L�C' Nailing Addreaa C, Ay)�4L,fe Howe YRone city/Stat./zip , �- • 7L'/ ;I ausioesa Mean 1. Haan en posit/ATC It oifte—t than Above Halling Addr.aa City/state/zip 3. Application For, '13 ito :1raluation aprovasont Permit/ATC ❑ Both 4. sister to sec+ic.c-OOU9e D Mobile Hama D Duaiacba ❑ Iadni;Lry 0 Other S. type system raquoeteda 13 coov.ationsl Q cowesitional modified ❑ lowovativ. 6. If Resistance. i People •-7 _ Y Bedrooms • a 112throoms .�tlbl alurasher ❑wrbag. Dlapraa`2-T— p lfscbiaeaeeent/Plumbiog ❑tiaseacnt/++o rlvsbiMJ 7. li ou.iae.s/Industry /otb.r: verity typoa P.opla a Sinks s Cusaadea a -+bore[. - I Urinals Y mater CooJera _ IB FOODSERVICE; # Seats. Estimated Water Usage toal3on. per day) 1. Type or water auyplTs ❑ 43ty/City D well ❑ cQuwa—ity P. Do you aoticipato additions or expansions of the facility !lal4 system is iulcudcd to serve? ❑ Yrs lryes,what type? My - 7 -29 - 0 Ya '•"/AUDRTANT*** CL1rW-SMUSrC0AfPLETE 1-1 THE KrQUIRED PROPEIVTY INFORMATION RL011'ftA BELOW, other a PLAT or SIM PLAN JOUST BE SUO IITTED by the client with TlitS APPWCATION. 1'roprtfy Dimensions: yt�v1 15 �r}y WRITE DIRECF[ONS (rro., ntorksratr) t. 1•RU1.6;IL'rl Tax Office PIN: 17____ Property Address: Road Name Citymp If in a Subdivision prtwide iaferma-ion, as follows: Section: Gloek: Let: Date kerac corneas (Is ggcd: ' • l7 O h�' 3aok 0 1413 This is to certify that the information provided is correct to the best of my kumviedge. I understand that any perotit(s) issued hereafter in subject to swpcusion or revocation. if Wo site pians or intended use change, or if the information submitted in this application is fnlsira,d or chanted. I, also, underslnnd that I awn responsible for off charres biaure i frnnr psis application_ 1, hereby, give consent to the Authorized Represtatativt of the Davac aunty 11ral n Ucparttnu+t to enter upon above described property located in Davie County and owned byeA44 zX !, ......_ .... .__. . to eouduct all testing procedures as wcessary to determine the site suite DATE A - 0 1�1 SIGNATURE THIS AREAWAY BE I=D FORDRAWING YOUR SIZE PLAN (luclude all oI the follotviut: Existing and propused pruperly Ilea and d4umSi=6 structures, setbacks, and septic tocatioas). Site Revisit ChuiZe Datc(s)- Client Notification Date: ERS: Signgivcn AccouutNo. Revised DCiID (0110] I>lvoiec No. f G �p �CEE W� 1!,='�RF50 '1'Llc ENVIRONMENTAL HEALTH DAV'IE COIATY n0N 1:011 SITE L'VALUATION/lAII'1IOVUILNT fL1011T & ATC Davie County Health Department EnY%rOn/IlentB/Hea/t/1 Section P.O. Dox 848/210 hospital Strect Mocksville, PTC 27020 (336)751-0760 * * *1NPORTANT* * * THIS APPLICATION CANNOT LIE' PROCL'SSis'D ULILLSS ALL THE REQUIRED - IIIFORMATION IS PROVIDED. Refer Lo L•ho INFORMATION DULLETIN for inoLl:uctionu. Jade Associates II, LLC Alan Jones 1. )lame to be Dillcd Con Lac L• 11craon Mailing Address Post Office Box 4062 Ifonlc 1'hunc City/,talc/GIP llucinuSe Thune tlinston-Salem, NC 27115-4062 (336) 759-9688 2. Ramo on Pc=it/ATC if Different than Above Mailing Address City/Stale/tip 7. Application For: E3 Site Evaluation ❑ Improvement 13cimiL/A1'C L1 B�L1h 4. 5yatem to Service: ® House ❑ Mobile Home ❑ DuctihlcL•D ❑ 1'lidusLry ❑ OLllcr - _- 5. Type system requested: I�1 Conventional ❑ conventional modified ❑ in(iovaL•ive G. If Residence: It People 4 II Dedrooins 4 II Bathroom:;2.5 tDiohwasher 6Garbage Disposal ]Hashing Machino CL711a::cwcnL/11lwnbing ❑Uat;cnicnL•/Ile Plumbing 7. If Dusincss/Industry /OLhor. verify type Il People 11 inls tl Commodes 11 Showers 11 Urinalo 11 WaLcr Coolers IF FOODSERVICE: If SeaLs Estimated waL'e1 UDage (gallons per day) S. Typo of water supply: M County/City ❑ well ❑ Conuuuliityy�tI 2. Do you anticipate additions or C\1):11hS1011J Uf flit Lll'lllty tills S)'StCill IS Jllll'll(ll'(1 (u sl'1.1'c'l ❑ yes DCNo If ycs, )%•ha( type? *"IMPORTANT*** CL1LN'fSd1USTCOAfI'LL•'TL:"FlIE lu,-QUIIfL•'D 1'1t01'lilt'11' 1NFORNIA-1-ION RLLtJI?STl-.*D BELOW. limier a PLAT orS1TE PLAN NUSTQESURA117TED by the clicut widITHIS Al'I'LICATION. Pruperl)• Diinensiulis: See attached map WRITE DIRLC1•IONS (1'rum Aluchwinr) t(, PRO1 Lat' T: Tax Office PIN: 11 5871615955 East on Highway 158, turn right onto Property Address: Road Nanic Beauchamp Road City/Zip Advance, 27006 11 iM a Subdivision provide infurnintion, as full uivs: Nal,lc: Proposed Jade Associates Scctiotl: Bloch: Lot: 24 Gun Club Road and proceed to the end of the road, turn left -onto Beauchamp Road and the site is located approximately Wo rules down Beauchamp Road on the right and left side of the road. 3/8/04 Date Ilonlc curners !lagged: This is to certify that file infornhatiou provided is correct to the best of shy )(1101 ledge. 1 understand deft any perrhlil(s) issued hereafter arc subject to suspension or revocation, if the site plans ul• intended use change, or if file iufurluadun subini((ed in this application is L•llsilied ur changed. I, also, run/e'rslrrru/!!rn! l uur reg/)urrsiGlc jut rrll chruSes iucurrrrl %tutu flus upplicariun. I, licrcby, gift Conschht to the Authorized 11cpi•cscII(at1Ye of till' Davie Culutly Ilpaldl De lard) Ln to cuter upon above described pruperly located ill Davie County and owned by Jade Associates to conduct all testing procedures a5 neccssary to determine the site suitaby. DA•flE 3/15/04 SIGNATURE r ✓'71�� TINS AREA MAY BE USED FOR DRAWING'IOUR SITE PLAN (Include all of the fullowhig: Existing and prupuscd property lines and dinleiisions, structures, se(bnclts, and septic locations). Sign given Site Revisit Charge Datc(s): Client Notification Date: Ells: Arrmmf Nn "4_"41Tj 1 DILkI10011 . I DF41M.1 ' :: vuI jI Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003105 Tax PIN/EH #: 5871-61-5955.24 Billed To: Jade Associates II, LLC Subdivision Info: Prop. Jade Assoc. Lot # 24 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map Date Evaluated: I Water Supply: On -Site Well Community Public ✓ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L_ Slope % 420 HORIZON I DEPTH - . - 3 Texture groupe— Consistence Structure U Sok Mineralogy 1 HORIZON II DEPTH 4 0 X731 14 Texture group C_-} _<'-, C'1 Consistence 01591 5s5p Structure Mineralogy HORIZON III DEPTH "5L Texture group S'+C.L- Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: r LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscaae Position EVALUATION BY: c� ' �-�A"`' 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)