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123 Meadows Edge Drive Lot 3Account #: Billed To: Reference Name: Proposed Facility DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Moeksville, NC 27028 (336)751-8760 990003530 Tax PIN/EH #: 5871-61-5955. 03 RC Robbins Construct.Co., Inc. Subdivision Info: Meadows Edge Lot # 03 Location/Address: Meadows Edge Dr. -27006 Residence Property Size: see map ATC Number: 4021 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 WASTEWATE STR VA D FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: :]3 1Aj0S I CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Com . he tem described on Improvement/Operation Permit has been installed in compliance with Article a er OA, Section .1900 "Sewage Treatment and Disposal Systems," but shall in N WAY be taken as a ar t that the system will function satisfactorily for any given period of time. 1�0 '/06 Septic System Installed By: Environmental Health Specialist's Signature: 0< /2 Date: r or DCHD 05/99 (Revised) I► 4r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section S' P. O. Boz 848/210 Hospital Street �^ . ' Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003530 Tax PIN/EH #: 5871-61-5955.03 RC Billed To: Robbins Construct.Co., Inc. Subdivision Info: Meadows Edge Lot # 03 Reference Name: Location/Address: Meadows Edge Dr. -27006 Proposed Facility Residence Property Size: see map ATC Number: 4021 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of septic tank system or anywastewater 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 1 I 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 _ 6S6 #People L4 #Bedrooms _�— #Baths �+ Dishwasher: Garbage Disposal: ❑ Washing Machine: C� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift ' (#Seats Industrial Waste: ❑ Lot Size e9AA Type Water Supply �Jn1rY Design Wastewater Flow (GPD) Site: New Repair 11System Specifications: Tank Size I= GAL. Pump Tank GAL. Trench Width `�'f I Rock Depth ' , Linear Ft. �W 0' Other: C5's-TeN%7i7 Required Site Modifications/Conditions: I "SrINLA- (2�0 C-c3..-)1We/ K, -P 6 liOl ,G, Q to oFFP¢dPc,.>v 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 in. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Ice oo� � so, K0.� 1 la Environme—n at Health S eciaiist's Signature: Pa: SS 0: P � DCHD 05/99 (Revised) -1/o n ICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department NOEnvironmentaiHeai i Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 �I��CA (336) 751-8760 *** ORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED NFORMATION IS PROVIDED. /Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed L)16 F� ,A 5 12- Contact Person ���-.�L �c� ♦ ,( "J�pJ -7S Mailing Address �JI S/,.1�� %�c.2��; N - Home Phone %Z,C, 4- 4- r City/State/ZIP C/ Lr -m, -n Ln/S NBusiness Phone 34- 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: A House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested: /9 Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms # Bathrooms 3 t12- 0 ishwasher ❑Garbage Disposal Erwashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /other: verify type # Commodes # Showers IF FOODSERVICE: # Seats # People # Sinks # Urinals # Water Coolers Estimated Water Usage (gallons per day) 8. Type of water supply: Er County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 216 If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. r � Property Dimensions: 1,1.3 )(2-11 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 71 - G I— �� � 5 JyioX /1 t _ , N [ Property Address: Road Name mrAixu 5 �^ I�C,1: �� ��t n1 421-a6 City/Zip Ahf A tJ C If in a Subdivision provide, information, as follows: Name: ,/ t'A�rA fJ t� 6 Section: Block: Lot: I0 JEy17z-e-,41,;-,f- A li .r�i 7—,4r121-) /G, 7- Ocel L- /-- Date Date home corners flagged: 3 a -c5-1 0 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 site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred fran this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE _ / / SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). C o , r Sign given t �P� - 3 LIq Revised DCHD (05/03 yl Ib ��t38, L. Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. 1 s -?iD Invoice No. '7 OV D R,�AR 1 2004 A I'LICATION 1011 SITE LMLUATION/IAIIll 10VL•'AIENT 111.1MIIT )ITC Davie County Health Department �VtRDNRlEtJTAlH90 EnviToilmenta/Hea/t/r 5ectio/1 ppV1EC0UPd1Y P.O. Dox 840/210 ilospiLal SLrccL Mocksville, NC 27020 (336)751-0760 * * *XKPORTANT * * * THIS APPLICATION CANNOT Dl; PROCL'SSLsD WILL•'SS ALL THE REQUIRED I INFORMATION IS PROVIDED. Refor to tho INFORMATION DULLETIN for instruction:,. 1. flame to be Dillcd Jade Associates II, LLC COnL'acL ller!jon Alen Jones flailing Address Post Office Box 4062 !blue fllonc City/;tate/GIP Winston-Salem, PJC 27115-4062 1luuinu,s (336) 759-9688 1'lwrle Namo on Permit/ATC if Different than Above Hailing Address 2 3. Application For: M Site Evaluation City/SLaLc/Zip ❑ Improvement hermit/ATC ❑ IJuL•h 4. 5yctem to Service: ® House ❑ Mobile Home ❑ DuSincL•a ❑ IndusL•ry ❑ OLller -_ — roe, ti 5. Type system requested: n Conventional ❑ conventional modified ❑ innovaLive 6. If Residence: 11 People 4 it Bedroom:; 4 II bathroomu 2.5 bOishwdsher In Garbage Disposal nklanhing ltachino ❑DasemcnL/rlwi:bing I3uasemenL/Ito Plumbing 7. If Dunincoz/Industry /OLher: verify type N Commodes I) Showers It uriliala It People II Sil les 11 Wa Ler Coole1J IF FOODSERVICE: 0 Seats EsL'imated Water Usage (gallons per day) _ __ 8. Type of water supply: IN County/City ❑ Well ❑ Corluuunity 9. Do you anticipate additions or uXpallSiolls of (lie facili(y this sysletu is iu(clrtled to serve? ❑ Yes n'u 1f yes, what type? 'IMPORTANT*** CL1EN'fSAIUSTCOili],LL.TG'ri1L Rl:'QUIRED 1'1(01'1:1('1'1' 1NV01(IlIXIION REQUESTEA) _ I BELOW. Either a PLAT or SITE PLAN HUST BE SUlJAM TED by the ciicnl 11 in1 '1'l I IS r11'1'I,IC,1'1'I ON. Pruner'!, Dilnctlsiuns; See attached map WRITE UIRLCl'IONS (Trull! Alucl;svillc) to T;ix Office PIN: 11 5871615955 East on Highway 158, turn right onto PropertyAddress: RoadNalnc Beauchamp Road City/Zip Advance, 27006 Gun Club Road and proceed to the end of the road, turn left -onto Beauchamp Road If in a Subdivision provide infut•nlation, as follows: and the site is located approximately two Name: Proposed Jade Associates miles down Beaucharip'Road on the right and left side of the road. Sccliall: Block: Lot;3 Date home corners (lagged: 3/13/04 This is to certify that (lie information provided is correct to the best of Illy Iutuldcdge. 1 understand that :uly perluil(s) issued hcrcaf(cr arc subject to suspension or revocation, if the site plans or intcudcd use cliange, ur if (lie iufurulatiutl submitted ill this applka(iou is bl5ilied ur changed. 1, also, understand t/rnt l (1111 respurrsiblc fur al/ c/rrus'es' irrcvrrrrrl %(1111( thisapplication. I, hereby, give consent to the Authorized Representative of the Davic Cuunry 11c:11(I1 1)c:``)arilllcn (o enter upon above dc5cribed pruperty lucated in Davic County and ulrlled by Jade Associ ates 1 I , LL� to cuuduc( all testing procedures as necess:tl'y to deterinine the site suitability. 3/15/04 SIGNATURE -- —' �/ DA "DATE THIS AREA MAY BE USED hOR DRAWING YOUR SITE PLAN (Include all of the fullolying: Existing and prupused properly litres and dinlensions, structures, setbacks, and septic locations). Site Rcl'isit Charl,c Date(s): Client Notification Date: Slgll giycn DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003105 Tax PIN/EH #: 5871-61-5955.03 Billed To: Jade Associates II, LLC Subdivision Info: Pro Jade Assoc. Lot # 03 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map Date Evaluated: ---2 �� Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut_ FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Fr 9S Structure C_ Mineralogy1 HORIZON II DEPTH 2.3Cc - 32 Texture groupC_ Consistence 3 —`S IF Structure k k Mineralogy HORIZON III DEPTH 3Z " Texture group -0,, 'C 4940 Consistence 5 Structure Mineralogy 1 1 i HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE r('} SITE CLASSIFICATION: Y LONG-TERM ACCEPTANCE RATE: ©• �� REMARKS: LEGEND Landscape Position EVALUATION BY: -cam's 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) ■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■SSSS■■■■E■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■E■■■■■■■EEE■■■■■■■■■■■■■■■■■■■E■■E■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ UMEMEME MEMNON MMEMMEEMMEMEMEMMEMNo ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■ ■ ■ ■ ■ t '21 LOT 134 S 89046"11 1 "E 38.07' OAK VALLEY P.B. 6 PG. 85 LOT 133 S 89045'03"E 84.97' (:I 5.08'g LOT 132 S 89046'58"E 19.96' rn I o I 1 N 1 1 3 40.33' = N 41.83' 30.46' 15.29' - - - - - - - - - - -- N N In N o 0O 1.50' p v� PROPOSED it O Z � HOUSE a V) N N $ 6.83' g -- -- _ _ _ _ -- �15.13'ri vi 13.13' 41.83' -- 1 I I m GARAGE n N N I 14.00' I 11.75 . 40.:13' Ih 8 I I ,m I I I I I. I .g I I� I Id I I - --------I-- - - - - - - - - � --- --- I 10' UTILITY EASEMENT I N 89044'36"W 143.00' MEADOWS EDGE DRIVE 50' R/W (aJ 10 m 00 W >E S EDOWS EDGE DR m x � o o MOCKS CHURCH RD LOCATION MAP \"N�1111111111111//IIM ki 0�•.•� FESS, ` tet'%� • Qo .Q SE AL c.: r L-2890 Q �C SURF. SITE PLAN ONLY THIS WAS MAPPED FROM A DEED OR RECORD PLAT AND NOT FROM A SURVEY BY M E. 30 0 30 60 90 GRAPHIC SCALE - FEET FOR ROBBINS CONSTRUCTION CO. INC. SCALE TOWNSHIP COUNTY STATE DATE,s 1 " = 30' FARMINGTON DAVIE N. C. 3-8-05 LOT 3 MEADOWS EDGE P.B. 8 PG. 143 HOWARD SURVEYING JOHN RICHARD HOWARD PLS P.O. BOX 276 ADVANCE, N.C. (336) 998-5396 JOB NO. 05038