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273 Indian Hills RdDAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax #(336)751-8786 OPERATION PERMIT Account #: 990004467 Tax PIN/EH #: 5768-99-3585 Billed To: George Morales Subdivision Info: lhdlan IMIS IS L4yle, Reference Name: Location/Address: Moh ''' ^'""6 Proposed Facility: Residence Property Size: 12 acres ATC Number: 4787 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. System Type 'Tank Size '�Z Pump Tank SizeTi/ t System Installed By: -016A V-fiZ E.H. Specialist:illd)ae-15)ate: (-9 Y—C/)g �� U �pP,b DCHD 11/06 (Revised) r 2� / � f ty Y -d /S is • DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville,NC 27028 IZI 1 101 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004467 Tax PIN/EH M 5768-99-3585 Billed To: George Morales Subdivision Info: Reference Name: Location/Address: Mohawk Lane -27006 Proposed Facility: Residence Property Size: 12 acres ATC Number: 4787 Site Type: R<ew ❑Repair ❑Expansion **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 OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms # Bathrooms 3 # People 3 Basement❑ Basement plumbing❑ Non=Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size 2' Type of Water Supply: [County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) y Tank Size GAL. Pump Tank _A4(h-GAL. Trench Width 3 Max. Trench Depth 3 « Rock Depth Linear Ft. - t As stated in 15A NCAC 18A.1969(5) Site Modifications/Conditions/Other: aes®pted SYstQmG may also be usecdi Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 = 9:30a.m. on theAay of installation.Telephone # (336)751-8760. OL 1, 3 M �14%^ rn it i Environmental Health Specialist Date: — U — b DCHD 11/06 (Revised) Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account M 990004467 Tax PIN/EH M 5768-99-3585 Billed To: George Morales Subdivision Info: Address: 141 Mohawk Lane Location/Address: Mohawk Lane -27006 City: Advance Property Size: 12 acres Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: L Tew ❑Repair ❑Expansion Permit Valid for: 25'Y—ears ❑No Expiration Residential Specifications: # Bedrooms 4 # Bathrooms 3 # People 3 Basement❑ Basement plumbing Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): 4 S r - Type of Water Supply: 6<6unty/City ❑Well ❑CommunityWell Site Modifications/Permit Conditions.: A5 stated in 15A NCAC 18A.196 acceptedSy-se-ms may also be use Environmental Health Specialist i.n.t 1-06 Date /1 –),o —07 '0 f E1 APPLICATION FO ,.,.. uunMZnANrt lti'3H#` aW�3 l0 -31-Zoo7 _ New ste INFORMATION EVALUATION/IMPROVEMENT PERMIT & ATC Are there any existing wastewater systems on the site? e County Environmental Health Does the site contain jurisdictional wetlands? 0. Box 848/210 Hospital Street 7 Are there any easements or right-of-ways on the site? Mocksville, NC 27028 Is the site subject to approval by another public agency? 6)751=8760/Fax (336)751-8786. Will wastewater other than domesic sewage be generated? Yes tPermit Authorization To Construct(ATC) Both o Existing System Expansi, odification of Existing ' mor Facility BE PROCESSED UNLESS ALL OF THE REQUIRED MATION BULLETIN for instructions. Name to be Billed (4er)me Cotact Person Billing Address Home Phone City/State2IP d Business Phone Name on Permit/ATC if Different than Mailina Address FKUFhK1 Y INUKMAIIUN *Date House/racility Corner NOTE: A survey plat or site plan must accompany this application. Included: Site Plan (Permit is valid for 60 months with site plan, no expiration with complete pht,) Owner's Name Phone Owner's Address CiV/Stat ip� Property Address Uy AA Lot Size Wr %P111\ Tax PN# !S'7(,8QQ Zi Rim Subdivision Name(if applicable) Section/Lot# Directions To Site: i�ir,.. ( W A�, 7-;-A t , Plat(to scale) Number EAR - Cald l If the answer to any of the following questions is `ryes", supporting documentation must be attached. Are there any existing wastewater systems on the site? Yes (2D Does the site contain jurisdictional wetlands? Yesto 7 Are there any easements or right-of-ways on the site? Yes Is the site subject to approval by another public agency? Yes Will wastewater other than domesic sewage be generated? Yes IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms_ Garden Tub/Whirlpool Yes No Basement: Yes No Basement Plumbinx Yes (1lo*) 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 requestd: Conventional Accepted Innovative Alternative Other Water Supply Type: Coun /City Water New Well Existing Well Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? Yes No If yes, what type? This is to certify that the information provided on tins application is true and correct to the best of myknowledge. 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 nformation submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Departmentto conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comas and locating and flagging or staking the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Property owner's or owner's legal representative signature Date(s): Client Notification Date: Date EHS: Signgiven Yes No Account# Revised 11.06 Invoice # d �-fi ANGELA V. PENLAND I I D.B. 195 PG. 636 I DANNY WALSER D.B. 113 PG. 44 \ , D.B. 126 PG. 250 ' I r ANTEONY B. BUTNEI? D.B. 359, PC. 188' I l il' E I �o S.R. 1613° n trpn 3 39' E� o 239. COar�Cai DRNB �f = ;:.. pw 1.l PAVED ,�►� Pf } v J 7 PAUL i c D.B. 17,'. e O 1 LARRY JONES D.B. Ito, PG. 399 s N IREA = 1 F.695 ACRES �. a_ AREA INCLUDES S.R. 1613 R/W PUwHOUSE U Q /. �u CECIL L. CRANFII,L/ D.B. 185. PG. 499 JR. `o / �• m � owlu,ec a" a I i� N 03' 6' Y"\.� .ac.nn 50. 00 mon N 93.03'(5• y LEONARD JONES D.B. 108 , PC. 172 100 50 0 100 200 300 SCALE IN FEET I hereby aertHy that I am me owner of the property shorn and described hereon, which located in the County of Davie that I hereby adopt this plan of subdivision with my free consent, Mabll.hed minimum building setback lines and dedicote an street.. alhy., walks, poen and other .Ree and a menl to public e prNate ted. Furth.man. I hereby dedlcat. all .unitary tors, d a erolines to the County of Dawe. DATE GEORGE tQ M DANNY WALSER D.B. 113 PG. 44 D.B. 126 , PG. 250 COAlMANCAM DRIVE >t F PUBLIC S_R. 1613 LARRY JONES D.B. 110 , Pc. sss yiron ---------------- R -W = R`� Ov err N a r DEIIRORlB' ✓, CRANFILL D.B. 532, PC. 903 S.R. 1613 1Fp N IN FJOLPT WW)R SUSDIK"M I, jAxly L hAl—. In W.- Lard 5u Vey.. Wmb.r L-]521 ,teary ig one or nae of the Hllb g a lhdlvat.d by on X: -a. 'loot the N a � ar a retry that cmtee ubdm,b 0 Ipnd rkhln m of a ,aunty ar munWpoaly that ha. an it _.a toot regale.. para.. der k.M; _b. That the plat a of o .uny that 4 kaabd In r,ah a porton o/ o oauft or munkipaey Uwl 'r anreeublM dee In on rdlnana thatr.pAd.. pamN of IoM: _e, Thal lhl. pial a of o .umy of an .60N parcel or porwN of IoM; _d. That .1. Plat a el a awry of anofhw -to"..ucn a the olo hi aeon of ..Mtnyy pparvv..N, v swat-wdend ou-'. w hw ..a.puon to the d.anMon of a .ubdiVoinn; the Inlwmnaon _1.be M lhN sura der le w,G, that I on, unaMo to rtae a d.t.nnlnatbn to tM bol of my pMwe(oal .Wa to p -bion. —rood In a through A abw�.. PL5 X527 306 urryar Rp`erauan WrtiMr ANGELA Y. PENLAND D.B. 195 , PG. 636 1 I I I I LNY B. BUTBdB I I D.B. 359 , PC. 188 1I I I j I I I' im .auto r `4RZe4 TRACT f 1 z 59z acR�,s a14E,g TRACT' ,[`//_J'^//7 ` 103 'GBPS V 41NG LEONARD JONES D.B. 108 , PC. 172 8K q PG-zOc� Filed for pr glshutlon at LZZ_o'dock P_M. SCDRhf�rO/J . 2007 aer and n^ded In Pid Book �, PagPa� Foo; ti r ped. W OW SIgV - MME Ce RMhr of par by --r MPum-Afdr — I I I I I I I PAUL d. CARTER der, a D.B. f75 , PC. f f o 3� 3= 1 'S9d6 I, Orally L Tutleror, certHy Mat thl. plat was drown under my ..perW.lon /nm actual e y made adesception oder my Supervl.lon (deed recorded in Book _; Po9e =, eteJ (atherJ;thal the aWa .turrrrfr.rrr baaneaeee oat .arvy.d a leery mdlaatee . dro.rn from Inforrnatlon found in PL Book Po9e QKNC�O`.,� Q ESai' that the ratio of pr.chion M calculafod as 1• Z 0� '�- that thh plat ra prepared M attordana Rh 47-30 a. amended. Wet— my 091nal elgnotun, _ SEAL r°eQylet�Mlon nu r d seal I. �_ day of x-25277 - 0 [jJi3l D.. 007 (Sed or Stamp) Registration Number ,,r'IlirNrr REVIEW. OFIFICCER'S CERfF1CATE I,"AJ,u,rli✓tl( RMerof er of 0", Ceunry, rtHy that the p plot to Whkh thh cortiReatlon I. affix mat. M Ftatutory reWinmsnts far recording. o v7s l RENEW OFFlCER DTE NO OVAL REQUIRED By DANE COUNTY P IN DEP EM. P1.94NING DEPARTMENT DATE 1. TOTAL TRACTS_ 2 2. TOTAL AC.- 17.695 AC. 3. EXISTING DWELLING WITH PRIVATE WATER SYSTEM AND PRIVATE SEPTIC SYSTEM LOCATED ON TRACT 1. 4. NO NCGS GRID MONUMENT WITHIN 2000 FT DARLENE S. B'ARRIS D.B. 178 , PG. f30 PLAT MAP: GEORGE L. MORALES OWNER ------------------ DEVELOPER GEORGE MORALES 141 MOHAWK LANE ADVANCE, N.C. 27006 (335) 986-6343 FULTON TOWNSHIP DAVIE COUNTY, NORTH CAROLINA TAX MAP: I-7 PARCEL 58.01 DATE: AUG -28-2007 SURVEYED BY: TUTTEROW SURVEYING COMPANY 107 NORTH SALISBURY STREET MOCKSVILLE, NC 27025 (336) 751-5616 - 100' 100 50 0 100 200 300 SCALE IN FEET FRE NAME: COORO NAME DRAWING NUMBER: MORAL -PT SHANKI-44 14907-3 GoMAPS - Davie County NC Public Access Davie County, NC - GIS/Mapping System Page 1 of 1 Oast Click Here To Start Over Quick Search: {County ID c Active Layer. y JI/ Use Map Tips GIs �' 0 PARCELS (Map Tips Available) Map Layers I Results I http://maps.co.davie.nc.usIGoMapslmap/Index.efin?mainmapservice=gomaps&CFID=412... 11/7/2007 GoMAPS - Davie County NC Public Access Davie County, NC - GIS/Mapping System Page I of I Click Here To Start Over Quick Search:(County ID c ActiveLayer.R-Use .,*sI-ap7-tps GIs 0 0 PARCELS (Map Tips Available) (S E,PP I -:J r4ap Layers I Results I http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=412... 11/7/2007 • ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPTax PIN/EH #: 57MMO MY INFORMATION Billed To: George Morales Subdivision Info: Reference Name: Location/Address: Mohawk Lane -27006 Proposed Facility: Residence Property Size: 12 acres Date Evaluated: Water Supply: Evaluation By On -Site Well Community Public ✓I Auger Boring_ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position [_ Slope % : I '�` . 3 HORIZON I DEPTH -- Texture grou Consistence, ! r Structure Mineralogy5 E O HORIZON IIIDEPTH '7— Texture group 1G Consistence ,1 Piv .Structure' iF Mineralogy, HORIZON III DEPTH Texture group•. Consistence Structure Mineralogy• 0 HORIZON IV DEPTH �l a Texture group Consistence v` Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE I CLASSIFICATION Lj c LONG-TERM ACCEPTANCE RATE ). r : - 6.a Z SITE CLASSIFICATION: J( -"A A Y LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: PN O`o J.) 6Ck \%-o y\ S y 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 1�e1< 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 ]Yates Horizon depth - In inches Depth offill ll - 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 05/05 (Reviser])