The URL can be used to link to this page

130 Meadows Edge Drive Lot 23DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003645 Billed To: Mitch Lowrey Construction Reference Name: Mike Sloane Residence ATC Number: 4487 Tax PIN/EH #: 5871-61-5955.23 Subdivision Info: Meadows Edge Lot # 23 Location/Address: Meadows Edge Dr. -27006 F'ror)ertv Size: see ma As stated in 15A NCAC 18A.1969(5) accepted Systems may also be usess 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 WASTEWA CTION VALID FOR A PERIOD OF F VE YEARS. Environmental Health Specialist's Signature: N Date: 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 given period of time.r�, M Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ` P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 66( (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990003645 Tax PIN/EH #: 5871-61-5955.23 Billed To: Mitch Lowrey Construction Subdivision Info: Meadows Edge Lot # 23 Reference Name: Mike Sloane Location/Address: Meadows Edge Dr. -27006 Proposed Facility: Residence Property Size: see map ATC Number: 4487 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a 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 HQO&E #People #Bedrooms 3 #Baths 3,6 Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing:. Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0,71 ACi�LS Type Water Supply�"---&Iv( Design Wastewater Flow (GPD) 3LO Site: New 12"' Repair ❑ System Specifications: Tank Size 10W GAL. Pump Tank GAL. Trench Width " Rock Depth 12� ' Linear Ft.JS As stated in 15A NCAC 18A.1969(5) Other: srkl6o , 1� L. accepted Systems may also be use as Required Site Modifications/Conditions: 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.**** N_ rq 3 ER ANA -1Z hlO r �' �' f GLV• t., iac Environmental Health Specialist's Signature: DCHD 05/99 (Revised) IA&x TRD" -DOPM 35" --F LJonIa' POMP &9Z, �Sr�IF.� A..t?M3in�4 Date: ©(O res f, 0' o N 0.69 acres f o N 1.04 acres t z z S 89044'36" E 760.00' Meadows Edge .give 3044'36" W 563.12' i.00' D 3 acres f 40' Front MBL (typ cal) 40' Front MBL (typical) f 1 y Q N Q to J 22 J `` �(� J N�� o N 0.71 acres o N in in in (n �n U , (Public 50' R/W), I•• S• 21 CO 0. �� N• 0.71 acres f N a� a� L . �n I N 30' Rear MBL (typical) 1 130' Rear MBL (typical) 30.64' 39' 15'50" W 134.00' 73, S 89'44'36" E .36' EIP) 3/4"EIP (bent) 2 � RLY 20 0.86 acres t FH 134.00' 268.00' j Ref. IRS, S 81' 39' _ 6 _ (Public 50' R/W), I•• S• 21 CO 0. �� N• 0.71 acres f N a� a� L . �n I N 30' Rear MBL (typical) 1 130' Rear MBL (typical) 30.64' 39' 15'50" W 134.00' 73, S 89'44'36" E .36' EIP) 3/4"EIP (bent) 2 � RLY 20 0.86 acres t FH 134.00' 268.00' j Ref. IRS, S 81' 39' _ 6 _ Rug 18 06 12:01p clavie county envhealth 336 751 8786 p.l L nq, ATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC v Davie County Health Department Environmental Health .Section ` - 2 TOP.O. Box 848!210 Hospital Street 3 Mocksville, NC 27028 P�G (336)751-8760/ Fax (336)751-8786 onFor- ite Evaluatior0inprovement Permit ❑ Authorization To Co tstuct(A1'C) Both QF IMPORTANT`. THIS APPLICA'T'ION Ct NNOT BE PROCESSED U YLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Re fer to the INFORMATION BULLETIN for instructions. N Name to be Billed /1 _ w� ,q a Contact Person 1ke A96, e- 5" Billing Address / 3 t2 As A Home Phone City/State/ZIP 1;nsfnn 6�1e-A, IwIc 7-7/oS Bw;inessPhone 33(•-77 3952 Name on Permit/ATC if Different than Above ; A �l t C— Mailine Address City/StaWZin PROPERTY INFORMATION NOTE: A surveyplat or site plan must accompany this application. (Permit is v lid for 0 mont w h site p n, no expiration wt orrt p a .)! Street Address L - City it VCZ�ax PIN# Subdivision Name 7r! o wYS SectionfLot#_ Lot Size Directions To Site:Oa-Rna J!j 4-p Pd. (e('+ )nf- Wcut-owSE Date House/Facility Comers,Flaggt d CD If the answer to any of the following questions is "yes", supporting documen.ation must be attached. Are there any existing wastewiaer systems on the site? ❑Yes l390� Does the site contain jurisdictional wetlands? OYes H<0 Are there any easements or right-of-ways on the site? ❑Yts W`11-0 Is the site subject to approval by another public agency? ❑Yrs l< Will wastewater othet than do nestic sewage be generated? OYts GKO IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms A # Bathrooms 1'1z- z- Garden Tub/Whirlpool es ❑No Basement:CYe-s ❑No BasenuntPlumbinit: EF es ❑No IF NON -RESIDENCE FILL Our THE BOX BELOW Type of Facility/Business Total Square Footige of Building_ # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seati Type system requested: 1.Z nventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type:VCountyfCity Water O New Well UExisting Well O Community Well Do you anticipate additions or expansi ,ns of the facility this system is intencled to serve? O Yes allu 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 revocs.tion if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I undowland that 1am responsiblefor all charges incurred from this application. I hereby grant right of entry to the Authorized Repre::entative of the Davie County Health Department to conduct necessary inspections ilq_cj�te 6mpliance w' h applicable lawn and rules on the above described property located in Davie County and owned by W � n _. Site Revisit Charge Property owner's or owner's legal repi !senV signature Date(s):_ `2 9 Client Notification Date: Date EHS:_ Sip given'']Yes❑No Account# Revised 2/06 Invoice # 7`1`_ Z13 AUG -22-2006 01:39P FROM:OTIS JONES SURVEY 3367257645 TO:7946264 P.1 P 4T5`1 CAP -TM MGI= R Bi RO 0.9.4b2- PG. (04-1 zo ' N. sm 3?- zv ,t . �• ho �o' 2� 4i N O` N O � N Z N N In • •y � t` N a 4A2 42.59 == Qtlsr HD Jx p ."C.4'j totri th t,o' t0 it-i'sI X5 6+.o , I p' wrz.. J' R.62 --- I -; E2dn r S. aT 44.31," e. sc MEADOWS EDGE OQ\ue (FOBLIC So' R-1ui Br -a - - - - -- Rlw'l LOT 23 MEP-Oouas EDC,6 906s E 1 SCALE' 1 "1= 36' ---------- 2004 I ENVIRONMENTAL HEALTH D"VIE COUNTY 'LIGATION 1:011 SITE L•VALUATI0N/IAII1Ii0VUIL'NT 1'L1b111T & /C1'C Davie County Health Department EilYirolii»enta/11e,7N, Section P.O. Dox 040/210 lfoapiL•al Street Nocksville, NC 27020 (33G)751-0760 ***I1.IPORTANT*** THIS APPLICATION CANNOT DE PROCESSED WILLSS ALL T1[E IZEQUIRED — I I1IFORMATION IS PROVIDED. Refer to tho INFOI(MATION BULLETIN for instruction:!. Jade Associates II, LLC Alan Jones 1. Name to be Dillcd ConLaCL Person Hailing Address Post Office Box 4062 Mane !'hone City/State/'LIP llinston-Salem, llusinuus 1'lIuiLe NC 27115-4062 (336) 759-9688 2. llama on Permit/ATC if Different than Above Nailing Address City/StaLe/'Lip _„•__.,_..,.,,, _.•_-,_•_.• 3. Application For: 1f Site Evaluation ❑ Improvement Penni L•/ATC lJ 110th 4 9. Syctem to Service: ® House ❑ 1101:kile Home ❑ Duninc:;a L4 S. Type system requested: Ill Conventional ❑ conventional modified c. If Residence: Il People 4 U Bedrooms 4 Liallwasher InGarbage Disposal nWashing Alachino 7. If Duslncss/Industry /OLhor: verify type N Commodos I! Showers ❑ Industry ❑ OLhCr-- ❑ innovaL•ivu II Bathroom.; 2.5 MI3ascu1cnL/I1lw0b1ng ❑Ua: ewonL/llo Plumbing 1) Puoplc I! ;iuls 11 Urinala 11 WaLer CooloiJ IF FOODSERVICE: lF Seata Estimated Water Usage (gallono per day) 8. Type of water supply: Lv County/City ❑ Plell ❑ Conuuunityli5 9. Do you anticipate additions or CXI).UIS1o11S Uf 111C facility this S)'S(Clil 1S illICIRIL'(I lu SL'1'1'L''l ❑ B'L'S C[Y I�1I If )'cs, 11'ha( type? **!AIPOR7'AIYT*** CLILN'rSd1USrcoiiiLL•'TG'r11L RL'QUIRL-D PROPLI(TY INFORMATION RLIQULSTED 3ELOW. !shier n PLAT orSITE PLAN 41USTBE- SUU1111TTE-D by the client »itll'1'1115 Al'1'LICA'I'ION. Proper(. Dilncusiulls: See attached map Tax office PIN: !l 5871615955 Property Address: Road Name Beauchamp Road City/'Lip Advance, 27006 11'Itl'1'L UIRLCTIONS (Pruitt Aluchs6l1c) lu I'HUI'iat'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 Hill a Subdivisioll provide infurlllalioll, as fullolrs: and the site is located approximately tOo Nallic: Proposed Jade -Associates iAi1es down Beauchamp Road on the right and left side of the road. 3/8/04 Section: Bloch: L 23 Lot: Date home Corners Ilagged: This is to certify that (lie information provided is correct to the best ol'luy knowledge. I understand that ally I)ernlii(s) issued Hereafter arc subject to suspension or revocation, if the site plans or intended use Cll;u►gC, ur if lhC iufurll)a(iun submitted in this application is falsified ur changed. I, also, understand that I «In respullsiblc jur rill chalj es ill cvlrl•cvl.%rulll this applicativa. I, hereby, gi%-c consent to the Authorized Representative of the DmIc Cuuuly Ilcalth De :11 -hi ” to cII(cr upon aboI-e described pruperty lucatcd in Davie County and owned by Jade Assoc1 ates 4I , 1_ to cuuduct all ICS(illg procedures as 11CCC55aI'y to dC(Crlllille tllc Site Sun(m, . 3/15/04DA'I'1 SIGNATURE - TINS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of lllc fullowhig: Existing and prupused property lines and dinlensiolls, structures, setbacks, and septic locations). Yen Site Revisit Charge Daie(s): Client Notificaliun Date: Arrnmd Nn DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003105 Tax PIN/EH #: 5871-61-5955.23 Billed To: Jade Associates II, LLC Subdivision Info: Pro Jade Assoc. Lot # 23 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map Date Evaluated- 3I Water Supply: On -Site Well Community, Evaluation By: Auger Boring Pit Public - Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH b - Texture group Consistence' Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy , ! HORIZON III DEPTH Al 7M Texture group 5 It cl_ Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: ) LONG-TERM ACCEPTANCE RATE: I REMARKS: EVALUATION BY: � 1,4ZWaka OTHER(S) PRESENT: LEGEND Landscape 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) A