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155 Meadows Edge Drive Lot 6CONSTRUCTION AUTHORIZATION Davie County Health Department f<g 210 Hospital Street �. P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 / For Office Use Only "CDP Fite Number 121870-1 County ID Number: E8.160-AO.006 Evaluated For: EXPANSION �, Township: 0 6/ 2 5/ 2 0 1 8 Applicant: Steve Buddie Property Owner: Steve Buddie Address: 741 Temescar Way Address: 155 Meadows Edge City: Redwood City City: State2ip: CA 94062 State/Zip: NC Phone #: (605) 399-6258 Phone #: (605) 399-6258 - -y #: Subdivision: Edge— Address/Road Phase: Lot: 6 155 Meadows Edge.-: Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 158, right on Hwy 801 s. Right on Mocks Church Rd. Right on beauchamp Rd. Right in Meadows Edge, Home # of Bedrooms: 4 on Left. # of People: -Water supply: tvA /Site Minimum Trench Depth: 2 4 Inches Classification: PS Saprolite System? OYes ONo Minimum Soil Cover. Inches Design Flow: 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 - 3 Maximum Soil Cover: Inches *System Classification/Description: 'Distribution Type: GRAVITY - PARALLEL (eq. d -box) TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: Gallons 'Proposed System: 25% REDUCTION 1 -Piece: OYes O N o Pump Required: OYes ONo OMay Be Required Nitrification Field Sq. ft. Pump Tank: Gallons No. Drain Lines 1 -Piece: OYes ONo Total Trench Length: 1 0 0 ftGPM—vs— ft. TDH Trench Spacing: — Inches O.C. Feet O.C. g Dosin Volume: Gallons _8— Trench Width: Inches 8Feet _ Grease Trap: Gallons Aggregate Depth: inches " Pre -Treatment: ONSF OTS -1 OTS -II K Septic Tank Installer Grade Level Required: 01 011 0111 ON / Pagel of 3 CDP File Number 121870-1 Repair SystE eaair System .Site Classification: pS County ID Number: E8 -160 -AO -006 ❑ Open Pump System Sheet :OYes ONo ONo, but has Available Space Design Flow: 4 8 0 Soil Application Rate: 0 3 "System Classification/Description: TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Trench Spacing: 0 Inches 0. Feet O.C. Trench Width: Inches Feet Aggregate Depth: inches Minimum Trench Depth: 2 4 Inches Minimum Soil Cover. Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: Inches Sq. ft. "Distribution Type: GRAVITY - PARALLEL (eq. d -box) Total Trench Length: 4 0 0 ft. Pump Required: ()Yes ONo OMay Be Required Pre -Treatment: ONSF OTS -1 OTS -11 'Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. "Permit Conditions The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit not to exceed five years, and maybe Issued at the sane time the Improvement Permit issued (NCGS 13OA-336(b)). If the installation has not been completed during the period of validity of the Construction Penna, the information submitted In the application for a permit or Construction Authorization Is found to have been Incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall become invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance; monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO ApplicanULegal Reps. Signature, Date: 'Issued By: 2244 - Daywalt. Andrew Date of Issue: 0 6 / 2 5 / 2 0 1 3 Authorized State Agent:��,tr►J�Q���G� Malfunction Log OYeS 01 -land Drawing Olmport Drawing Total Time :(HHa,1tt) **Site Plan/Drawing attached.** 0 1 . Hours . 0 rt mutes Page 2 of 3 S-9 - CA'S issued - expansion CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 121870 -1 210 Hospital Street P.O. Box sas County File Number: Es-�soA000s Davie County Health Department Environmental Health Section 00�v�vv 2J D&I RECEIVED P.O. Box 848 �3y ., 210 Hospital Street Courier #: 0940-06 Mocksville, NC 27028 32( Phone: (336) - 753 - 6780 JJ�� ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Fax: (336) - 753-1680 Name: _S (jp— &ca Phone Number t..t1J� ' J L�," �p �� (Home) Mailing Address: / /6-X4062M (Work) /Zepa, ocls F Tlob v Detailed Directions To Site:.8-ot S. Property Address: J SS' Ynpa rain -0S g&c'e, W sjaAcg-1/t( Please Fill In The Following Information About The EXISTING Facility. " � Name System Installed Under:_, � I: ,[n Lb Ove L,.. Cml 1 • Type Of Facility: Date System Installed (Month/Date/Year):Ste)DS Number Of Bedrooms:`Number Of People: Is The Facility Currently Vacant? @ No If Yes, For How Long? Any Known Problems? Yes No If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: Im Number Of Bedrooms: Number of People Pool Size: arage Size: C9 Other: _ Requested By: Date Requested:—2y (sign to ) /% For Environmental Health Office Use Only Approved Disapproved Environmental Health Specialist Date: *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended o _ ited) that the on-site wastewater system will function properly for any given period of time. n1 Payment: Cash ' Check Money Order # 6 /-"r Amount:$ I VU • U V Date: I-V- Paid � j Paid By: Received By: 4'Il,GiY _ Account #: Invoice #: ' 577 Appraisal Card Page 1 of 1 UAV1C LUUn1IT, ML 15.00 1 W D D 1 0/1U/21ILS 0:4/:4 AM UDDIE STEVE A BUDDIE HEATHER M Return/Appeal Notes: E8 -160 -AO -006 DATE 155 MEADOWS EDGE DR IFUS -2ILL -0 UNIQ ID 7093 +-16--+ 2527011 )ms BD11-15 ID NO: 5871623564 /U 1 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 1BAS eval Year: 2013 Tax Year: 2013 LOT 6 MEADOWS EDGE PHASE I 1.000 LT SRC= Inspection I Appraised by 19 on 11/04/2008 03007 BEAUCHAMP RD TW -03 C- EX- AT- LAST ACTION 20110712 ithrooms CONSTRUCTION DETAIL MARKET VALUE I DEPRECIATION CORRELATION OF VALUE I oundation - 3 1 3 200 3 6 3 3 Standard 0.0800 7 ontinuous Footing5.0 Eff. POINT VALUE BASE I IFOG I BUILDING ADJUSTMENTS I 1FGD I 1 I 2 I 4 ub floor System - 4 USE MOD Area UA RATE RCN EYB AYB REDENCE TO MARKET 5 8 F U S PI ood 8.0 01 01 3 227 133 93.10 302235 2005 2005 % GOOD 1 92.0 DEPR. BUILDING VALUE - CARD 278,06 xterior Walls - 21 TYPE: Single Family Residential Single Family Residential DEPR. OB/XF VALUE - CARD 3,65 ace Brick 37.00 MARKET LAND VALUE - CARD 50,00 xterlor Walls - 22 STORIES: 2 - 1.5 Stories OTAL MARKET VALUE - CARD 331,71 tone 0.0 ORIG Roofing Structure - 03 TYPE GS AREA % RPL CS ODE DESCRIPTIO able 8.00 TOTAL APPRAISED VALUE - CARD 331,71 Roofing Cover - 03 AYB El TOTAL APPRAISED VALUE - PARCEL 331,71 %sphalt or Com osltlon Shingle 3.0 _ nterior Wall Construction - 5 00 0 TOTAL PRESENT USE VALUE - PARCEL D wall/Sheetrock 26.0C TOTAL VALUE DEFERRED - PARCEL nterior Wall Construction - 6 OTAL TOTAL TAXABLE VALUE - PARCEL 331,71 Custom Interior 0.0 Interior Floor Cover - 12 PRIOR Hardwood 10.00 BUILDING VALUE 311,68 Interior Floor Cover - 14 OBXFVALUE 4,86 Carpet 0.02 LAND VALUE 50,00 Heating Fuel - 04 PRESENT USE VALUE Electric 1.00 DEFERRED VALUE Heating Type - 10 TOTAL VALUE 366,540 eat Pum 4.001 it Conditioning Type - 03 rr. 15.00 1 W D D 1 ms 2 1 DATE DEED IFUS -2ILL -0 +12-+ ++4+ +-16--+ BOOK )ms ++ +7-+ +-16-+FSP /U 1 PRICE IFUS -2LL-0 1BAS 9 2 Q I 1 +-13-++ +-16--+ ithrooms I I I I IFUS -0LL-O I 1 1 1 3 200 3 6 3 3 7 I +10+ +8-+-16--+ POINT VALUE 1121.00C 1 +---24---+ I IFOG I BUILDING ADJUSTMENTS I 1FGD I 1 I 2 I 4 1 1 4 4 4 ABAVG 1.200 ++ +- 18 - -+ 2 ++ ++6+ +6+ / Desi 4 FACTOR 4 1.050 6 6 F O P 6 5 8 F U S 8 1 1 3 Size 0.870 +-14-+-18--+ I +-16--+ 1 1 6 I +-12-+ ADJUSTMENT FACTOR 1.10 +10-+-14-+ QUALITY INDEX 13 SUBAREA UNIT ORIG TYPE GS AREA % RPL CS ODE DESCRIPTIO LTH H UNIT PRICE GOND BLDG L/B AYB El 1 86 10 17363 I ON PAVING 1 761 201 1,5201 4.0 _ 11 L 00 0 OB/XF VALUE OTAL rr. INDICATE RECORD DATE DEED SALES BOOK AGEJMR TYPE /U I PRICE 0681 0917 9 2006 WD Q I 3645011 0600 576 3 00 WD Q V 4800 0540 336 3 200 WD X V HEATED AREA 2,921 NOTES 1N0TAL ILDING DIMENSIONS BAS=W16 WDD=EI6 FSP=S9E16N12W16S3$ N14W2OS12E4S2$ N2W8S2W7N2W32S2W2S37E2S6E14 FOP=E18N6W18S6$ N6E18 D=S12ElOS1E14N25W24S12$ N12E24N16W13N9$ PTR=E30S23 FUS=N13E16S13 FOG=E16S14W6S11W12N11W6N14E8$ W8S14W4S8W16N8E2N14E10$ N23W30$. ND INFORMATION GHEST TNER AD]USTMENTSTOTAL D BEST USE LOCAL FRON DEPTH/ LND COND ND NOTES ROA LAND UNIT LAND UNT TOTAL ADJUSTED LAND LAND E CODE ZONING TAGE DEPTH SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADM UNIT PRICE VALUE NOTES R RES 0100001.000001.000050,000.0 1.00 LT 1.00 50,000.0 5000 SIZETAL MARKET IAND DATA 50,00 PRESENT USE DATA 0"bl) O r A http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=E816OA0006 6/10/2013 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 15x18&AdoWy "e.1 5871-61-5955.06 ML Meadows Edge Lot # 06 Meadows Edge Dr. -27006 see map Account #: 990003645 Billed To: Mitch Lowrey Construction Reference Name: Proposed Facility Residence ATC Number: 4123 Tax PIN/EH # Subdivision Info: Location/Address Property Size: mnl-,� y '956 -,/1 Z- 5 � s Bold i, i n -r— As stated In 15A NCAC 18A.1969(5) accepted Systems may also be used 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 ewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE RUC ON VALI R A PERIOD/OF FIVE YEARS. K F1 Environmental Health Specialist's Signatur Date: )S5 CERTIFICATE OF COMPLETION Iso **Dp OTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article I 1 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. �a. 01Y VT 14�k 1�7�s ZI Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 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 #: 990003645 Tax PIN/EH #: 5871-61-5955.06 ML Billed To: Mitch Lowrey Construction Subdivision Info: Meadows Edge Lot # 06 Reference Name: Location/Address: Meadows Edge Dr. -27006 Proposed Facility Residence Property Size: see map AO -A, --Ls' ATC Number: 4123 **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 V400Z #People #Bedrooms 3 #Baths Dishwasher: Garbage Disposal: Washing Machine: Er -11, Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 4''�S Type Water Supply Design Wastewater Flow (GPD) Site: New El"" Repair ❑ System Specifications: Tank Size's GAL. Pump Tank GAL. Trench Width Rock Depth 12 Linear Ft. 4 O AD 02tad in 15A NCAC 18A.198at5 Other: �' STQ-+ �Tlc� '� ++ ged Systems mey ulso ba t+¢' t Required Site Modifications/Conditions: t-,�5 Dhe-'l%= . �0�� �-^'1" IMPROVEMENT/O RATION 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 in. 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.**** E� 1 I e Environmental )CHD 05/99 (P � I ',�OJe Specialist's Signature: Jun 14 05 03:12p Mitch Lowrey (336) 794-8 C ` May 31 05 11:56a davie county envhealth 336 751 8786 P- l� iS v APPU morn FOR SITE �ALUAiIONAUPROM16yr PEI= ,& ATC � 3 . JUN 1 4 2005 • - Davie Courtly Health Department P-0- I Hospital a so n treot NC 27028 ENVIRONMENTAL HEALTH (336) 751-0760 1dtPORT/llYle** TfIIS APpLj IOUDAVIECOUNTY IMRM4?I03r IS PIIDM=. Refer tp I)S PRO==B2tLtsS3 ALL T88 RBQDIItgD ✓ . It+D'OldlJlnov BA8L81n for instructions. i elanw to be oalleo iii 17CH I.A.►pR`t P4sat�e /p./� IVjC. '/iraillay Aaarass ; 1 31'1 AIMCoatsot Persoa !)117Git !„o�R y ` atr/sceta/zzP W/NfSTo JAi,.--- � 1 no" JtLAn J►)G 2'!/ DuSalnesa Anon. -tea- soma oa Paaalt/nze at Daher. tbsa spar. 22 " 952 rn +raallaQ sddeou aSr/3t1ta/t1p'- --^3• Application ror. i�sitc Evalnatian D Ibapp=ovesnont Pesyait/A= (3 Both ..f Systea to Fairies. (House ❑ Mobile Home ,./ D Business D Indvat:ry 17 Other�,S• s)ps 'rat— reawst db p1 ConrMttayl ❑ oemranyt_ swdatiad If Residence: ■ People, D imovatira ,�// ttir �/ P Bedrooms ..�_ P Bathrooms` MDiegraabar earbeaa oaop"&' Dbaaamattt/Plwipaaq Daaae�ea ntYashtna Mae7.laa 7- rt 8uataws/I.�.atrY /Otdr. rwrity typo/ t/xw Ylaa�blay s / Paopla � / Sbowra _ 0 IIrio-1s 41o1cs a hater cool". TY "WSEMCEs SAata r-timated Hater Usage is -lions Por day) L!• Too of ester supply. i�Couaty/CSty O wen 0 Co�aity �� nO rO1 'c'clelyRC' addition o or crpandons of the facility this sysfen) is intended toserve? D Yes J lfycs,wbattypcl-.__.---•---�.. L)TNo -- rVKr +* C TS YSTCDd1pLETET1IX REQUJRBD PROPERTY llVFORb1ATION tIEQU>:ST&D BF.LO filWeraPLATo jS.BJVSUdM/7TCDbyHitdicer alts THISAPPLICATItKV, L--P"Pwy>hmcnsions: !ME -LJ --XX ZD.S7 D e—;vtuTEnla�CrroNs(r�omr�v ,tne)ferROt�tITT: l Tax OfticeNN: 0�5271 _1 S:9�_ _—PropertyAddrew RoaM= Me ,00Ljk. (Ir .. Itin a SgWirhien protide incarnation, r tallow: � Section: Btoek: Lot: ,�Q•„ Datc Dome cornus Daggcd:'�-•/�-i-_;r—_...� MIS to artily flat the latermadoa provide d Is correct to the best of my kaon tedgc. I understand that any perudt(s) Ism hereafter an subject to suspension or revocation, if the site plans or Wended use cbsa=c, or if the Iatormadou submitted to this appGtadou is fa)sired or clanged. t, d$o, asdorsraad riisttam reveirsoleferalf dWrgcg urcarrcdfrvw lids appli-d— I, b-cby, Dtvvaaseat to tbe.4uthor&cd Reprcustadre of the Davic County H-akb Department to enter upon above described property located in Davie County and on ed by to Conduct all ICS049 procedures as accessary to detetadne the site suitabiti4: „-DATE 3 f) o S' XGr4ATURE 77115 AREA MAYBE USEDTOB D)IAWINp YOUR SITE pLM (larlude all of Ibe foIIotiriar Faistluc proposed Property tines azul diumusiocs, structures, setbacks, and septic locations?. Site lie -16f /h..... Datc(5 : Cheat NotiftMUM Date.- SIP ate:SIP Zil."Aeeoaat No. � S Rcslscd DCHD {QSlD3 Iavoicee No. � ! 1 Jun 13 05 02:26p C Mitch Lowrey i (336) 794-8264 M 1—J t. - p � 'a g, _l - ab Vb 2 � -1c1.7� i SO Via' u74 µ.ii°:- -44.` 36"\$4. EFtOov�S EDCYE G Id WU40: SO SWZ 80 'LCT ;n1 ER DOW S -4: GCYE pVA-sc ! SV9L SZL+ 'ON Adzi p.2 3 N 6UT53A IS Sauor 9[30 wDa� r -o v, ry of 129 IP .97' 60.00' )rive W3 W 134.00' RRQ'4A'4R"P .102. * 50 L'ti.LJ 1.04 acres f 20' Public Drainage Easement 77.92Cl- Corner N 44'41 (Public 50 R/W), 27 BC --BC S 89'44'36" E 10' Utility Easement Fr 146.87' m 40' Front MBL (typical)l l 16 0.75 acres f r_ V) N O Ln vi fO N I C 0.69 o U_ Q � LO 21 CO L. �Im � N � v N. 0.71 acres � � CU l 16 0.75 acres f r_ V) N O Ln vi fO N I C 0.69 p ECCE WE MAR 15 2004 ENVIRONMENTAL HEALTH DAVIE COUNTY TION f0li SITE L'VALUATION/IAII'IiOVLAILNI- PElfi111T & 11.1'C Davie County Health Department Envi1'Oni»enta/Health Section P.O. Dox 848/210 IlospiLal Street Mocksville, NC 27020 (336)751-8760 ***1HP0RTANT*** THIS APPLICATION CANNOT DL PROCESSED WILLSS ALL TILL REQUIRL•'D INFORMATION IS PROVIDED. Refer to the INFORMATION DULLETIN for inrtruCtioll_l. .IF FOODSERVICE: It SCaLB Estimated Water Ucago (uallons per day) 8. Type of water supply: I� County/city ❑ Well ❑ CouwluuiLyW 2. Do you anticipate additions or expansions Df the facility this systerll is ill (clldCd to serve? ❑ yes Oe1 No If ycs, what type? ***1AI1'01(TAIN'T*** CLIEN'rStllUSTCOAI!'LL•'•fC'r1IL AL•'QUTAED PROPLI(TY IINVORNIATION ItiiQUESTI•:u —I BELOW. Either n PLAT orSITE PLAN rUUSTBESURHIT%GD by the elicit rrilh'I'IIIS r\I'I'I,ICr\'PION. 1'rullcrly lliuleusiul,s; See attached map WRITE UIRL•;CTION(1'l'uul Nucl"villc) lu I'ItUI'I{I(TV: Tax Office PIN: ll 5871615955 East on lli ghway 158, turn right onto Property Address: Road Name Beauchamp Road City/Zip Advance, 27006 If in a Subdivision provide information, as follows: Nalllc: Proposed Jade, Associates Gun Club Road and proceed to the end of the road, turn left -onto Beauchamp Road and the site is located approximately t epi1es dorm Beaucharap Road on the right and left side of the road. Scctioll: Bloch:: Lot: 6 Date home corners !lagged: 3/8/04 This is to certify that the information provided is correct to the best ol'uly luluwledge. 1 understand that :u1y perulil(s) issued hereafter arc subject to suspension or revocation, if tllc site plans or intended use cll:ulge, ur if the illfor111a(iuu submitted ill this application is falsified ur changed. I, also, audei-stand that 111111 I-egwasiblc fur rill charges ill clu•rrr! fruul this application. I, hereby, give cotlscut to (hc Authorized Representative of the DaviC Cu un ()' Ilc:ll(11 Dellau•tW n call to cuter upoabove described pruperly located in Davie County and uwrtcd b), Jade Associ at II to conduct all le5ling procedures as uccess:u'y to determine the site suits lily. 3/15/04 DATE SIGNATURE I �C TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of (lie fullowitug: Existing and proposed property lines and dimensions, structures, setbaclts, and septic locations). Silc Revisit Charge Date(s): Clicu( Notification Date: EMS: Sign gig cn� 3,( Q w- ��,L)g -!6197 Jade Associates II, LLC Alan Jones 1, name to be Gilled Contact 1'eraon Post Office Box 4062 Flailing Addreso llo,ue I'liune Ilinston-Salem, PJC 27115-4062 (336) 759-9688 City/State/'LIP lluuiltuns Phuue 2. !tame on Permit/ATC if Different than Above Hailing Address City/State/Zip 1. Application For: 01 Site Evaluation ❑ IulproveulenL- Permit/ATC ❑ DL)L•h 5. Syctem to Service: ® House ❑ Hobile Home ❑ Du:;incLs ❑ Industry ❑ OLlicr _ ti 5. Type system requeoted: El Conventional ❑ conventional modified ❑ innovaL•ive 4 4 2.5 6. If Residence: I1 People 11 Dcdroomc II DaLllrooln:. tDiahwasher raGarbage Disposal nWashing I•lachino ❑UasemcnC/Plwiil�iug F,111aGCmCl1L/IIu Plumbing 7. If Duainess/Industry /other: verify type It 11coplc 9 Commodes It showers 11 Urinalo It Water Cooler:! .IF FOODSERVICE: It SCaLB Estimated Water Ucago (uallons per day) 8. Type of water supply: I� County/city ❑ Well ❑ CouwluuiLyW 2. Do you anticipate additions or expansions Df the facility this systerll is ill (clldCd to serve? ❑ yes Oe1 No If ycs, what type? ***1AI1'01(TAIN'T*** CLIEN'rStllUSTCOAI!'LL•'•fC'r1IL AL•'QUTAED PROPLI(TY IINVORNIATION ItiiQUESTI•:u —I BELOW. Either n PLAT orSITE PLAN rUUSTBESURHIT%GD by the elicit rrilh'I'IIIS r\I'I'I,ICr\'PION. 1'rullcrly lliuleusiul,s; See attached map WRITE UIRL•;CTION(1'l'uul Nucl"villc) lu I'ItUI'I{I(TV: Tax Office PIN: ll 5871615955 East on lli ghway 158, turn right onto Property Address: Road Name Beauchamp Road City/Zip Advance, 27006 If in a Subdivision provide information, as follows: Nalllc: Proposed Jade, Associates Gun Club Road and proceed to the end of the road, turn left -onto Beauchamp Road and the site is located approximately t epi1es dorm Beaucharap Road on the right and left side of the road. Scctioll: Bloch:: Lot: 6 Date home corners !lagged: 3/8/04 This is to certify that the information provided is correct to the best ol'uly luluwledge. 1 understand that :u1y perulil(s) issued hereafter arc subject to suspension or revocation, if tllc site plans or intended use cll:ulge, ur if the illfor111a(iuu submitted ill this application is falsified ur changed. I, also, audei-stand that 111111 I-egwasiblc fur rill charges ill clu•rrr! fruul this application. I, hereby, give cotlscut to (hc Authorized Representative of the DaviC Cu un ()' Ilc:ll(11 Dellau•tW n call to cuter upoabove described pruperly located in Davie County and uwrtcd b), Jade Associ at II to conduct all le5ling procedures as uccess:u'y to determine the site suits lily. 3/15/04 DATE SIGNATURE I �C TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of (lie fullowitug: Existing and proposed property lines and dimensions, structures, setbaclts, and septic locations). Silc Revisit Charge Date(s): Clicu( Notification Date: EMS: Sign gig cn� 3,( Q w- ��,L)g -!6197 ii DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003105 Tax PIN/EH #: 5871-61-5955.06 Billed To: Jade Associates II, LLC Subdivision Info: Prop. Jade Assoc. Lot # 06 Reference Name: Location/Address: Beauchamp Rd -2700 Proposed Facility: Residence Property Size: see map Date Evaluated: S )0q Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % C �/ HORIZON I DEPTH © r Texture group Consistence Structure Mineralogy HORIZON II DEPTH r• Texture group CL. .0 Consistence !'5S5► Structure Q k Mineralogy' HORIZON III DEPTH '5717 Texture group ; Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ©. J SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscape Position EVALUATION BY: CJ _(qmL)eAAo-e 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) Davie County, NC - GoMaps Advanced Page 1 of 1 Davie County, NC - GGMaps Advanced 127 1 W N N 118 It ,p 124 85 85 85 94 102 167 143 136 215 243 8 4 a j 155 167145 X133 t3- �:.. 143? 143 215 I 86 MEADOWS EDGE DR '�'EAf?i;l',��,`S EDGE DR I L 125 134 134 147 I Q I I , Y l) 1 ' 40 m Cl. --*16�# 1 ]122 .. „142 152 10o ft NJ IV Latitude, 350 58' 28:13' Longitude; -800 25' 56.05" http://maps2.roktech.net/davie_gomaps/index.htmi 6/21/2013