Loading...
124 Meadow Creek Court Lot 30DAVIE COUNTY ENVIRONMENTAL HEALTH +^ ,� P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 990004197 Tax PIN/EH #: 5871-42-4592 Billed To: Harrell Construction Remodeling, Inc. Subdivision Info: Meadows Edge II Lot # 30 Reference Name: Location/Address: 124 Meadow Creek Court -27006 Proposed Facility: Residence Property Size: 0.94 P2o. u.3� ATC Number: 4561 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has 1 in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given time. System Type: S.T. Manufacturer�T4wTank Date Z—Z crank siz Pump Tank Size System Installed By: ` TAA L-�Mwn Ir 6 - too/44S / N �SYD Fb14►� DCHD 11/06 (Revised) I • j + DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 C�T AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 990004197 Tax PIN/EH #: 5871-42-4592 Billed To: Harrell Construction Remodeling, Inc. Subdivision Info: Meadows Edge II Lot # 30 Reference Name: Location/Address: 124 Meadow Creek Court -27006 Proposed Facility: Residence Property Size: 0.94 ATC Number: 4561 **NOTE**,`This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G. S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specification: Building Type X" r #People #Bedrooms `t" #Baths 3 Basement w/Plumbing: T Baseinent/No Plumbing Commercial Specification: Facility Type #People #People/Shift #Seats Lot Size ©� Water Supply Z�esign Wastewater Flow (GPD Site: New epair System Specifications: Tank Size ICWGAL. Pump Tank, GAL. Trench Width, "Trench Depth 34"A'!n1X Rock Depth Linear Ft. '0 4bc.r77a1 S ft Dysz; Required Site Modifications/Conditions: f'PJST —L-gj CryJ7arz Contact the Davie County Environmental Health Section for final `%r% o:�n n.9n,...- ..� aL., d.._...Q S....a..�l..a_..� T,.l..-.1... Environmental Health DCHD 11/06 (Revised) j4a:ps��Ilm inspection of this system ie # (336)751-8760. ween L,,tr F1 rldtiCll �V1L�0llUL- L1V1L M 1\C11Lkj%A%-111LE)l JUL Ll - .r APPLICATION R SITE EVALUATION/IMPROVEMENT PERMIT &ATC Davie Count Health Department Environmental Health Section D P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 PPI' .;, 7(h e`Evalua06 Improvement Pernut a"Authorization To Construct(ATC) ❑Both licatioWV IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION NametobeBilled �Ar,rckk � �°D6ConactPe on ` .i Billing Address City/State/ZIP V. , , A ok 3Lt& Home Phone IZ-1 u t.Z Business Phone 3 3 t "7G4 - 6 IN r S CLC- r. K o W s tit L 33 1 -7 -a V-— z..-7 S z Name on Permit/ATC if Different than Above Mailing Address PROPERTY INFORMATION NOTE: A survey'plat or site plan must accompany this application. (Permit is valid for 60 months with site plan, no expiration with complete plat.) Street Address 12-11 6C- C&aelc Ck . CityA�� Tax PIN# 14 z - MS 5 Z Subdivision Name Mem owy £b G,G- jr- Section/Lot# 3o Lot Size 6. g y Directions To Site: lS$ 4-b g -b Cos►— er-+ 4 Ek✓ CN.hv ,- Z Rd M i n✓ s C^,, c n r. Date House/Facility Corners Flagged ti j It, .0k ) o C If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? Dyes ONO Does the site contain jurisdictional wetlands? Dyes CKo Are there any easements or right-of-ways on the site? Dyes 01-�To­ Is the site subject to approval by another public agency? Dyes D<0– Will wastewater other than domestic sewage be generated? Dyes [31q'o-- IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms M # Bathrooms 3''z- Garden Tub/Whirlpool es ❑No Basement: ❑Yes 31 o Basement Plumbing: ❑Yes ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: Zonventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: 11-'C0unty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes EST o If yes, what type? This is to certify that the information 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 altered, the intended use changes, or if the information submitted in this application is falsified or changed. 1 understand that I am responsible for all charges incurred fi-om this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules on the above described property located in Davie County and owned by {} gr�e,t\ GovtS�ct� ci'f-re r.. e%.Q-rv� 1, t ---'t- Site Revisit Charge Prope owner's or owner's legal representative signature Date(s)• i It2w o 6 Date Sign given Dyes ONO Revised 2/06 r Client Notification Date: EHS: Account # 4// q7 7 Invoice # -9/t7-- e. T D ', . pnAP, 1 5 2004 M ENVIIt�N-AI. HEAETH DFVIE COUNTY TION 1011 SITE- 1:MMITION/IAIPROVLAIL•NTI'L•I111i1T & ATC Davie County Health Department &1YiT011111 Ata/f/e,7X1 Section P.O. Box 848/210 Hospital. Street rlocksville, 11C 27020 (336)751-8760 ***I1•IPORTANT*** THIS APPLICATION CANNOT BE' PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORt4ATION BULLETIN for instructiorn:l. 1. flame to be Dilled Hailing Address City/:,talc/'LIP _ Jade Associates II, LLC Contact Person Al Qn e -s • • Post Office Box 4062 ,nano Phone _ Kinston -Salem, NC 27115-4062 Duuiness Phu:rc (336) 759-9688 2. Namo on Permit/ATC if Different than Above Hailing Address City/State/Zip J. Application For: M Site Evaluation ❑ Ilnpl:ovclnent 11erlllit/ATC ❑ 17oth 4. System to Service: ® House ❑ 1•Iobile Home ❑ Dusinc:;s ❑ Industry ❑ Other ti 5. Type system requested: M Conventional ❑ conventional modified ❑ innovative 6. If Residence. It People 4 It Dedrooms 4 II Isatllrooitw 2.5 tDisllwashcr InGarbagc Disposal [Mashing Machine ❑ilasuu,ent/l'lwnbing ®DacmucnL/Ilu Plumbing 7. If Dusiness/Industry 10uhcr: verify type It 1'coplc. II Commodes It Showers It Urinals If !;inks Il Water cooler:r IF FOODSERVICE: it Seats Estimated Water Usage (gallons per day) 8. Type of water supply: In County/City ❑ Well ❑ ConuuuniL-1,f,�5 9. Do you anticipate additions or CXpa115iulls or (lie facility this S)'stclll is ill (ell ded to Scrl'e'I ❑ yes eCV NU 1f ),es, what tyle? ***1AI1'011Ti1NT*** CLIEN'FSBIUSTCOdIPLLTGTIIE R1iQUIRL•'D PRO1'ISI(TY INFORMATION RIL'QO iS' E'D BELOW. Either a PLAT or SITE PLAN MUST BESURAIIT%L'D by the clicnl lvilh 'I'IIIS r\ l'1'LtCr1'I'ION. Property Dinlcusiuls: See attached map Tax Office PIN: tl 5871615955 Property Address: Road Name Beauchamp Road City/Zip Advance, 27006 If ill a Subdivisioll pl'oyidc inful'1111tioll, as follows: Nalllc: Proposed Jade Associates Scctioll: Bloch: Lot: . 30 WRITE UIRECTIONS (trona Muclis%' llc) lu East on Highway 1513, 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 trio miles down Beauchaclp'Road on the right and left side of the road. 3/8/04 Datc home corucrs 1labged: This is to certify that the inforulation provided is co,•rect to the best ol'luy knowledge. I understand lllal ani, pernlit(s) issued hereafter arc subject to suspension or revocatioll, if the site plans u• intcuded use c11:111ge, ar if the inforulaliuu subHlitled ill this application is falsified ur changed. 1, also, understand that 1 uul r•rahurrsiblu jun• rill chat -'es incur-ed.lrurul thisapplication. I, hereby, give consent to the Authorized Representative of the Davie Cuunty IlpA(ll De :will nl to cntc,• upon above described pruperty located in Davie County and owned by Jade ASsoC1 Ates 4 I , LLC (o conduct all les(ing procedures as necessary to UClel'111i11e the Sitc suitls DATE 3/15/04 SIGNA'T'URE 4 �✓ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of life fullowinb: Existing and pruposed property lines and dimensions, structul'es, setbacks, and septic locations). Site Revisit Charge IDa(e(s): Client Notification Date: EMS: Sign gil'crl 'l'• ....r Wr •~ DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003105 Tax PIN/EH #: 5871-61-5955.30 Billed To: Jade Associates II, LLC Subdivision Info: Prop. Jade Assoc. Lot # 30 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map Date Evaluated: 1_12 p4 Water Supply: On -Site Well Community Public I/ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 20 HORIZON I DEPTH D^ l I O Texture group- : C Consistence S Structure 1c - Mineralogy 1 • ) HORIZON II DEPTH 32_ Texture group j5jC14- . "S10 Consistence r ' gS Structure Mineralogy' HORIZON III DEPTH —1 C1 Texture group S, L ' Consistence n7 $ N Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 1 EVALUATION BY: LONG-TERM ACCEPTANCE RATE: �'� OTHER(S) PRESENT: REMARKS: �Orlhe 1'w4y LEGEND Landscaae 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)