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164-165 Mohawk Ln (2) DAVIE COUNTY HEALTH DEPARTMENT �� '� ^ � � Environmental Health Section d^-�" , � P.O.Bog 848/210 Hospital Street Mceksville,NC 27028 . ' (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001132 Tax PIN/EH#: 576&87-7795.01 Bitled To: E. Kent Walser Subdivision Info: Reference Name: Kent Walser Location/Address: Mohawk Lane-27006 Proposed Facility: Residence Property Size: 1.50 Acre • q�� b r: 2416 **NO'I'�*��iis�mprovement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION 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/� ( � � #People� #Bedrooms�� #Baths� Dishwasher: �V/ Garbage Disposal: m�Washing Machine:�� Basement w/Plumbing: � BasementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 0 Lot Size /�� Type Water Supply I°Vcl/ Design Wastewater Flow(GPD) �� Site: New��pair❑ System Specifications: Tank Size p!� GAL. Pump Tank GAL. Trench Widt �� Rock Depth� Linear Ft`� . Other: �4 l� i ,,� 7" Required Site Modifications/Conditions: i` �� !�� 1 IN[PROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6°°BELOW FINiSHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m.or 1:00 .m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** �' ��X''��.fo�� •°�'�� . o,,,,E Q, �� 1 y�� /�C. �� Date: '�—�—D� Environmental Health S ecialist's ignature: C.� � . DCHD OS/99(Revised) ..� �� . , � � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001132 Tax PIN/EH#: 5768-87-7795.01 Billed To: E. Kent Walser Subdivision Info: � Reference Name: Kent Walser LocationlAddress: Mohawk Lane-27006 Proposed Facility: Residence Property Size: 1.50 Acre ATC Number: 2416 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLJED by the Davie County Environmental Health Section prior to issuance of any building permit(s). T'his 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ��----� _ Date:�j--�� CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate ofCompletion shall indicate the system described on ImprovemendOperation Permit has been installed in compliance with Article 11 of G.S.Chapter 1 ,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarant t a the system will function satisfactorily for any given period of time. � / \ � Septic System Installed By: �( n /"'��`� /f Environmental Health SpecialisYs Signature: iL ��L( Date: �`'/ � �� DCHD OS/99(Revised) // APPLICATION FOR SITE EVAt�lAT10N/IMPROVEMENT PfAMR&ATC � � � Q�� /�tv�'�'Cq!! (� �� Davle County Health Depa�tment D y `� p.o eo�;��o��,p�o�..ti APR 2 �. «�:,, �� . l3ockevill�, NC 27028 � • (336)7g1-8760 �**Sl�ORTANTR** T828 ]IPpLIC�1TION GIA170? � p1tOC6B8�D UNLa88 712.L TEi� REQIIIR�D - _— INa"OR�ATiON i8 PACVIDED. R�fsr to th� I�t�"ORMAT=O�i 80IS+�TI�i !or iastruationa. �. �.,. � �. ��.� � ,1��-/)�.�'�� t �.� �..,.�,�, 1�,��. 1fai3iAq ]1ddr... �T Q7 aA' f,u��//��i lto�. Pha1. _�aZ o� cshr/aaa/s:p �}'�/El,rl c P_ �� 2 �d D�. swin... rhon. �. 1taa� os� P�raib/7►TC i! Di!l�zrat tbai► 71bo�� ailinq �ddr��• Citr/itat�/!ip �. 7►ppiioation ror: 6a'Sit� sv�lustio o Improvam�at P�rmit/]►Tc �oth �. s�.t.s to s.�sw� 0 Sous� (YMobile 8om� 0 Susin�ss 0 Iadustsy 0 Oth�r a. i! Raaidu►a�: t peopl� � i Sedrooms � i Batbrooms �- f8'Di•hx�st�s [3'II�Sb�Q� Dispo��l B"RashiaQ fha�� O B�s�s►t/Dluabiaq O Sasdant/No pl�hinQ 6. !! Suain��/indu�try/Ottur: fp�oily typ� i �api� t siak� � Co�od�� 82►ox�r� f Oriaal� � 1r+at�r Cool�r� st r00D8sR'VZC3: � 8�ata =stims�d wat�r O�aq� c�lon. �.r a.Y� �. �p� o! xat�r suppiy: 0 Couaty/City [�/ft�ll 0 Community e. Do yon anticipate additiow or ezpanelow oi t6e fAcWty thb ryttem la inteaded to rerve? 0 Yea 0 No V yes,whst type? **�IMPORI'ANT"**CL1E[V'i'S M[!S1'CIUMPLETETHE REQUIRR�sDD PROPERTY INFORMATION REQUEStED BE[AW. Either a PI.AT or SITE PI.AN M[1ST BESUBhfITTED by t6e client w�it6 THIS AL'PIICATION. Property Dimenstona: �s � �f C��-- WRITE DIRECf10N3(from Mak:ville)to PROPERTY: Ta:Odlce PIN: # .��f��}�7 7 ��9 51.0/) �, � �Q� ro •G c�'/Z �j� ..�'��'(,�}/� . / �L �. . j Properly Addrea�: Ro�d Name �d,�7QLu� ��1 G�6 TO �i��ir�j�t fl�,�i L. o h ' Ctty/Ztp��L�'l�C E' � ,� �� 1��1't� � ��(�� It in�Sabdivision pravlde In[orm�Hon,aa follmve: N�me: SecHon: Blocks Lots Dak Property Fla�alt �—�'�� o d T6is is to cerHFy t6at t6e informstion prwided is correct to t6e beat oi my kamvledge. I anderabad that�ny permit(�) iseued 6ereafter Are enbJect to sa�penaian or revocAHoa,ilthe eite plene or intended ae�c6an�e,or ii t6e InformaHon eabmitted in t61s applicsNon L�faL�ttied or e6an�ed. l,also,r�nderstand tArat 1 ane raponsl6le jor all clFarges lncurred frone tils appllcaHon. i,hereby,Qive conaent to the Aat6orized RepteaenbHve o!t6e Dirvie Connty Hailt6 Department to enter apao above dea�r[bed property lodited in Dsvle Coanty and awnal by to conduct�q testing procednra ae nccesasry to determfne t6e dte taitabWty. DATE 'i�'� �—ov SIGNATURE �� l��.T- /�[/ THIS AREA MAY BE USED FOR DRAWII�IG YOUR SiTE PLAN(Inclnde all of the[ollm►iag: Ezlatina snd propaeed propecty Unes and dimension�, etructarea, eetbAcka, Aad sepNc IoatHoas). Sih Rcvbtt ChsrQe D�ts{a): Client NotiAcaHon D�te: EH3: �� Accoant Na ��. Revised DCHD(07l99) Iavoice Na � / `�� . Y.�. � ND AT THE OF TAX — ' �EXISTING FARM ROAD NOTE: ACCESS TO THIS PROPERTY HqS BEEN OVER THIS--J � - EXISTING FARM ROAD FOR THE PAST 45 YEARS +/- �� THIS FARM ROAD LEADS OUT TO PUBLIC ROAD "INDIAN �I DONALD R. JONES a/w DOROTHY C. JONES HILLS ROAO (S.R.1613) // DEED BOOK 100, PAGE 165 ��°N�"E �� TAX PARCEL 61 i� S 86°20'46"E ;;� 2330.50' crorn�� 1001.45' , --oW yAS 86'20'46"E W S 86°20'46"E a� �1'�.s 1329.05' o � 302.�0• N" o N 302.01' o �� g . .- p o N NEIf LOT�S �• g^ �ACRES to o \s\� 20'00"W 687.70' � �� N M 1 Z 302.10' z 302.01' o gP/L ��Q a— 86�2��}� O � � �—�N 86°Z��W ��79.23 EIP Fd. 3.27' EIP Fd.3.14' N 86 2� �� R '�'° SOUTH OF P/L SOUiH OF P/L ` '�.—. TIN E. f �'Fd.3.33' EIP Fd. 2.95' HERMAN A. � / SOUTH OF P/L I SOUTH OF P�L S►�a� o�o� � TON POND � � SUTTON � I � � CEL487 �e.s3, Pc.4�2 � ,��,; I CHARLES L. ' STANLEY D. TURNER �,� I TAX PARCEL 38 I A 4� LONG DB. 131, PG. 64 � �1,.,� � � � DB. 88, PG. 362 I DB. 197, PG. 135 ''`� �, � H �a TAX PARCEL 40 TAX PARCEL 42.01 / �4`* / � � �� ANU � � � W�� a � �a� . � ��.�N Ca�O,,� A PROPOSED NE, DO CERTIFY THAT THIS PLAT WAS `��Q.� ,.�•� •.., ��i, DIRECTION AND SUPERVISION FROM AN ;� ;•�Er�SSIp�`��,'� PREFORMED UNDER MY DIRECTO�N AND ` 'Z';�QQ "� : � TAX MAP RUE AND CORRECT TO THE BEST OF �S��, i��G� �k�� < ELIEF . �D : �.�3�b:S Q,: �� I-7 SIGNATURE, REGISfRAT10N NUMBER, 2' :�Z:r,y �� °' = TAX BLO AY OF �P�/G , 20 D� : ••��SUR`��O: �i��O••.......••'��,� ��-.--�`-�--Q ��'''�EE�'�`��` T AX L OT , PLS L-3063 TWO NEW LOTS TAX PARC0. ^ , �,_,�r c , , DAVIE COUNTY HEALTH DEPART'MENT • Environmental Health Section . Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001132 Tax PIN/EH#: 5768-87-7795.01 Billed To: E. Kent Walser Subdivision Info: Reference Name: Kent Walser Location/Address: Mohawk Lane-27006 Proposed Facility: Residence Property Size: 1.50 Acre Date Evaluated: �—�� Water Supply: On-Sit Community Public Evaluation By: uger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition Slo % HORIZON I DEPTH ,► ,.- Texture rou Consistence 5 � S Structure Mineralo ' ` HORIZON II DEPTH , � Texture rou ,�- Consistence � ' �,j Structure � Mineralo ' / t HORIZON III DEPTH Texture rou Consistence ' Structure Mineralo � HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE / CLASSIFICATION LONG-TERM ACCEPTANCE RATE o a . SITE CLASSIFICATION: � EVALUATION BY: LONG-TERM ACCEPTANCE RATE: o OTHER(S)PRESENT: REMARKS: 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-Prisma[ic Mineraloav 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-gaUday/ft2 DCHD OS/99(Revised)