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129 Brookmead Court Lot 18DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002436 Billed To: Darren Burke Constr. Reference Name: Proposed Facility Reesidence ATC Number: 4210 Tax PIN/EH #: 5871-61-5677.18 DB Subdivision Info: Meadows Edge Lot # 18 Location/Address: Brook mead Court -27006 Property Size: see map As stated in 15A NCAC 18A.19S9(5� accepted Systems may also be use 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 .1909, Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CON N IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: Q 2Z - V 6T 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 U Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. QO1Q,V- L1 5TD U4rA f T"x LAW 11-2-1 Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Q� 3 MMU ljc5x� Date: 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 Billed To: Darren Burke Constr. Reference Name: Proposed Facility Reesidence ATC Number: 4210 /.c -b Tax PIN/EH #: 5871-61-5677.18 DB Subdivision Info: Meadows Edge Lot # 18 Location/Address: Brook mead Court -27006 Property Size: 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 1 Otc#People 3 #Bedrooms -f-) #Baths 7 - Dishwasher: Dishwasher: l]2'� Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: i5 Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size b.5AW5ype Water SupplyLw—rIy Design Wastewater Flow (GPD) �0 Site: New Repair ❑ System Specifications: Tank Size /OO iAL. Pump Tank GAL. Trench Width � 1 Rock Depth %z It Linear Ft. qCk�y As stated in 15A NCAC 18A.1969(5) Other: 3 ��i� tgt?170-)- accepted Systems may also be use as Required Site Modifications/Conditions: IQa-T� v-) co-frGoQ 5 `'� t7r`11iA1 tDJ� I O d 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.**** � r i Environmental Health DCHD 0/99 (Revised) j-+L--AZ,b I-tjgS: i t3 ature: Date: <N �p • r,,, �r, A 3' A S 0:5 2 . O f 275•Zx 4/a 50- !BB 99 , L 22� / 4 .s1. 9 9�Z e .91 ia�Q Sep 22 05 08:41a Darren Burke Construction 336 778 0436 p.1 N 1� LO rr t'd djo:eo so *T unr f/• r LO rr t'd djo:eo so *T unr Sep 19 05 01:56p Darren Burke Construction 336 778 0436 Jun 10 03 11:14a davie county envheaIth 336 751 8788 p.2 APPLIGI'JIGM l0lI SIIE EVALVAT10N/INNWVE%IENT PEWIT h AIC Davie County Health Department E0kYA 4B*IIl91)& 7 M-5041% rJ P.O. Box 840/210 Hospital Street UDckoville, NO 27028 (336)751-8760 ..*,TNPOdtTA1Vr**9 THIS APPLICACAtM TION Or BE PROCESSED UNLESS ALL MM REQUIRED neyORXATIDN IS PROVIDED. Refer to the INnXISATION BULLMIN for instructiono. ��11 wi c WOW 1. to be Billed Q0'Pn 1"i9Ati. ChVA1 )& &i-"Omtact person --... rnl2ios Poor". ��!1�, /> �a/f\�+� t9�srl.�C uoao pbooe Mar/staee/zlr _ X�l°Cri! —/t JC_ J _ Hualtew Triooe Cj - iCC �1 '1 a. Nw as aeralt/ATC It Differeut wi— Above U.il Leg Add... 'rlC.t.�--L-�' Citr/atnte/%iP -.. ...._ -_ a. Applicstioa Vora\Jsite :-Valuation laprevetnant Pert/ATC pt h n (1!((( S. System to tervice�,�[I,r�ouse Q Kobile Nome t] Business 0 Iodustry D Othcr S. Type system request Cbn+.ntimal D eaa.enUoval .odilied 0 SMrwativa s. Sf Resideaee: a People s Bedrpoo= 3 s Dathrooas ' �sanvasAe�r f]tisrbape tilepnsal /GIIAahi:g MaeAias blBrseaeat/P'lusJllsg DBasomentJsa rlwrDlnq 1. If aasiaevellnduetry !other: verily type f a fowls • sink. a e tea• • Shaven ' s Urimin a hater Coolers _ IP FOODSERVICE: 0 Sosta Estimated Nater Usage laallone per dayl a. Type of water e%pp1Y1pd f,oalty/City 13 Well 13 coommunity s. oo you Latieipate asattiess or e:panalm S a[ the facility llg$ tystcrn h lutendcd io suvi! O Ycs II ym eta 7)x' "'11KP(1RTAATs• CLIQ7_S/t L0747OUPI.E7ETHE RtQUIRLD PROrtXCtl` INFORMATION NEOtIh5P1 U BELOW. Eldtar A PLAT orSlrB PLAN stVSTDESU8A/ITTED by tic clicsl with THIS APYLICATIOM LY�� XJyWRITE DIRECTIONS (hve-hJu Lsritle)Rot1tt11•EIVI'V:PropMyDimcesioas:F�eFSQ7TarOfeel'lN: t PropertyAddras: RoadlYamc (P�� 'l� u ` �'4` � �IT`I�vU��.►�� __ �y�p yd,5ep p,414? eL i , , - Z (r1aR gni ► _ If in a Subdivision provide Informv..io0, as foram- �/ � 1—' /f%'.tib Z?" Cc Section Block: Lo i Dale Ione corers nagged: �I p.2 SEP 19 2005 ET�17RO,7"'Irr At H6qu}j DAWE COU, This is to certify that the information provided Is torrett to the (lest of tliy Iuiosrlcdgc. I andtrslaad that any pwout(s) issoal bereniter arc subjwt to saspensdoa or revocation, if thesite plans or intended use cbaugejor if the infornimiva sabtailled in tisk appliinlion is !a[siru!d pr eliangnL I, alas, ujidervand that I ass strltartsrblcjirr all chmYrs iusenrrril Jrum this application. I. berebyr give eotaent to the Aetltorized AeprescutzWe of pix Davie Com uty t Icaltk D arilucs t to enter capon about described property located in Devic County and esrsxJ by d u> J'L to conduct all testing procedures as Ib4*=ry to deterw(ne the site suitabilit s l DATE �I SIGNATURE THIS AREA MAY BS USED FOB DRAWING YOUR$= PLAN (Include alt of the fo)loliutp l'uig and proposed property Maes and dlmosions. structures, selbacltsr and septic locations). Site Revisit Charg¢ Datt(s): ctient Notification Datr. EUS: C sign Oven Account No. o 3 T RCvissdDCHD(Q!iM Invoice: No. �� u DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003105 Tax PIN/EH #: 5871-61-5955.18 Billed To: Jade Associates II, LLC Subdivision Info: Prop. Jade Assoc. Lot # 18 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map Date Evaluated:ZJ�210bf Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 3 4 5 6 7 Landscape position L_ L Slo e % 7-ID 2V riL 0 HORIZON I DEPTH O - 7 - Texture group C Consistence f Structure L Mineralogy HORIZON II DEPTH 1' S Z Texture group S 50 Consistence $ -' S 5S PV Structure Mineralogy HORIZON III DEPTH Texture groupSa Consistence pS Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS = RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE b•. o, -s SITE CLASSIFICATION:hh5 LONG-TERM ACCEPTANCE RATE: V EVALUATION BY: o"'^VC tlA+,p OTHER(S) PRESENT: REMARKS: v.�$ r1 l�� , Si�4�Ax`wz-� ) /n)Ttr(IL tZ�?f3� �RQ+•.� LEGEND Landscane 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)