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164-165 Mohawk Ln DAVIE COUNTY HEALTH DEPARTMENT /�`� `J��6'�� . ' � Environmental Health Section . ' P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001132 Tax PIN/EH#: 576&87-7795.02 Billed To: E. Kent Walser Subdivision Info: Reference Name: Kent Walser Location/Address: Mohawk Lane-27006 Proposed Facility: ReSidenCe Property Size: 1.50 Acres ATC Number: 2422 **NOTE'�* T'his 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 , o� #People� #Bedrooms_1 #Baths�_ Dishwasher: �/ Garbage DisposaL• L�Washing Machine: �Basement w/Plumbing: ❑ Basement/No Plumbing:Q� Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size , �� Type Water Supply�� Design Wastewater Flow(GPD)c�''« Site: New��Repair❑ �� r� System Specifications: Tank Size%0 GAL. Pump Tank GAL. Trench Widt}�� Rock Depth� Linear Ftt� Other: Required Site Modifications/Conditions: INIPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6`;BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Deparhnent for final�nspection ofthis system between 8:30 a.m.to 930 a.m.or 1:00 p.m.to 130 p.m.on the day of installation. Telephone#is(33G)7 1-8760.**** �lL � ��ty �� °F� {�ro L°�lEs. °�r�s �P �� ''xl� ''x ��' L.o;.�. ,��-�-� °�-�� I�� 0 m � Environmental Health Specialist's Signature: cc�� .S Date: ��/�`� DCHD OS/99(Revised) �`� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001132 Tax PINJEH#: 5768-87-7795.02 Bilisd To: E. Kent Waiser Subdivision Info: Reference Name: Kent Walser Locafion/Address: Mohawk Lane-27006 Proposed Facility: Residence Property Size: 1.50 Acres ATC Number: 2422 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLTST BE ISSUED 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 Articie 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: �� S Date: S-/�� o� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemenUOperation 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. 1 f'P� -�_ �� I 1 � � � �' 1 �� ' '�� 0 Septic System Installed By: , / G ��'^•� ✓ Environmental Health Specialist's Signature - '` -" Date: —" '-� � DCHD OS/99(Revised) , f APPUCATION FOB SITE EVAWA710N/IMPROVEMENT PERMR d�ATC � � � a v � �l G,��S�.� Cq�/�a � Davle County Health Oepartment D � � y � � Env�lrvnmenla/He�sJtfiSestlon APR 2 4 �G�� (;Q��vs' P.O. 8ox 8�8/Z10 Ho�pital BttNb /O . �iock�vill�, NC 2y028 � . (336)7'Si-8760 *t�S�QRTlIN?*** �IS 11PpLiC�1TIGN GM�OZ B� PR0�88�D UNL388 I1L?. T� RSQZTIttaD A�'01tMl1TtON 28 pACV2DBD. R�t�r to th� i�ORMAT2C�i BnLL�T=N !or iastruatioas. i. �... to b. asu.a � 1�.�2�"��r��/ contawc r.r.oa ��i�li" ,�, �r.•r,f9E�� I�.suaQ �des... �7r 7 .i � .a.(''�!t��d� aoa. ffion. �r'9fl' �5 .,Z Q„� / �— Csts/�tat�/szp �!7'//c7�?C c�_ �� 2 'fd 4�• swiw�s phoes� Z. 11w on ��it/7►iC it Di!l�r�s►t thats �bo�� ltailie�q �dds�s� Ci�/�tsb!!ip a. J►ppiiaatioa ror: B'Sil.� evaluatio o smpsov�mant B•xmitll►TC r'Both u �. sg.t.s to s•r.so.: O Hous� Mobil� Hom� O Busin�ss O tAdustsy 0 Otb�r s. _! R�sidusa�: � p�opl� �_ ! B�drooms ,� � Bathrooms �_ a�ciahw..4�as �saiaq. oispo•.1 [�'I�ShiaQ �aahis►. o aasa�.nt/alu�bsaQ 6l-s�.a�ab/lio al�oniaQ 6. it swiu��/tadwtsY/�� tYp� t D+api� 1 siak� ! co�od�� i sbo�r� � t�rinai� f 'Rst�r cool�rs It rOCDSZMIICl: � 8�st� istimat�d liat�r U�aQ� t�i�• r� �+Yl �. �ycp. or x.t.= .upp�Y: o couutY/raty �r.11 o co�.tY e. Do yoa xnNctp�te additiow or e�andow otthe faeWty thb�yttem b intcnded to urve? �Ya 0 No V ya,w�h�t type? **'IMPORTANT"**Ct.1ENT3 MUxTC�OMPIETETHE REQUIRED 4ItOPERTY[NFORMATION itEQUE3TED BELOW. EltLer�PLAT or SIT�PI.AN MUST BB SUBMITTED by the clleut w�ith THI9 APPWCATION. Property Dimenfiows �� /�-��-- WRITE D1RF.GTIONS(from MafaviUe)to PROPERTY: Tss 081ce PINs 1! ��1 t��7 7 7CJ � (�c�) l�s � �Q� � �c�'/2 �i' ..�%xb y� Property Addrass Ro�d N�me �d�7C1Ltf� ,�.h Cd `TO�..�l��i��J�r�rj�r,�,i �. o/� - ' C1iyiZip � hC E �� h��,l�,�/1� � ��006 . V tu�Sabdtv4lon provtde lniorm�don,�u fottmre: N�mes &cHon: Blocl�t Lott Date Prop�rty Fls�al: ,'�"",�'{— o d T6b b to eertify tbat tbe tntormstion pravided b eorrect to t6e beat oimy lcnawltdga I a»dernand th�t tay permtt(t) laaued 6eresRer sce�ubJeet to wspenston or revoe�Hon,II the�Ite pl�a�or tateaded ose ehao�e,oc if t6e!o[ormallon iabmttted in thV appltcaHun is tnlstQed or e6ad�ed. l,aLso,aadtrstand tiat 1 o�n rapotulbl�jor all cArargu lncumed jro�n t�ls appllcadolr. I,bereby,�ive eoueent to the Aat6orized Repressobttive ot the D�vle Coanty HaitL Department to enter npon sbove desccibed property locsted In D�vie Coanty�nd mnin�td by to condact aU tatin�procedara��nec�saary to determine the dte�ottabWty. DATL 'if r� �— a d SIGNATURE '1/ TH13 AREA MAY BE USED FOR DRAWU�IG YOUR SiTL�PLAN(Include all oi t6e follm�inQ: Esi�tin�and propaded prnpsrty Ilna and dimewiow, �trnctnra, utbac{u, snd�+eptic locattoni). Site Reviait Ch�r�o � Date{�)s Client Noti�caHon Dstes EftB: Accoant Na � RlViud DCHD(O7/99) LlYOICE N0. �� , _ � ND AT THE OF TAX � � ' �EXISTING FARM ROAD NOTE: ACCESS TO THIS PROPERTY HAS BEEN OVER THIS�� - 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 ROAD (S.R.1613) // DEED BOOK 100, PAGE 165 ��°N�"E �� TAX PARCEL 61 S 86°20'4fi"E %� • 2330.50 Roru� 1001.45' , a �AS $3 20'0 ��E - -'QW S 86°20'46"E a� ��•�.s 132s.05' � ir� � N pN 3�2.�� O ��i � N NEIf LOT 1 M� p� M � p� �s'0R M � 1.50 ACRES �e o� �p �RES � o \�1 � � N N O N '� M ` 20'0 0"W 687.7p z 302.10' N o z 302.01' �=�N 86°20'00"W 1029.23 P�� Q �— H6°ZO'OO"W� N gg�ZO'OO"W ��A E1P Fd. 3.27' ElP Fd.3.14' � —�.�— SOUT}{ OF P/L SOIJT}1 pP p�� EIP Fd.3.33' EIP Fd. 2.95' TIN E. HEftMAN A. I � / SOUTH OF P/L 1 SOUiH OF P/L Po"p o��,�,, o� 7.18'NO TON / SUTTON � I � � CEL 37 �B.a3, Pc.4�2 � ,�%�,� I CHARLES L. � STA1�II,EY D. TURNER �,� I T,vc PARCE� 3s I a U I LONG I � q D8. 131, PG. 64 ^ 06. as, Pc. 3s2 ' DB. 197, PG. �35 �' � � �a� TAX PARCEL 40 TAX PARCEL 42.01 �a� I � I W �� '4NU � O / w Ma� M V c7 �a� � ��r•N CA�O►,�� A PROPOSED NE, DO CERTIFY THAT THIS PLAT WAS `��Q� ,.•�� •.., ��i, DIRECTION AND SUPERVISION FROM AN ;Q :•�F�rSS►p,�,'�.,��y'� PREFORMED UNDER MY DIREC701NAND �Z,�QQ' "�': ; TAX MAP RUE AND CORRECT TO THE BEST OF s S�A, ELIEF . i��'ti�.��-30�k�`�- —�_ SIGNATURE, REGISTRAnON NUMBER, AND ��;,�q OQ;2: I-7 AY OF �P�iG , zo�� :Z'••.tiosuaJ�:��O� TAX BLO �.;��• ...0��,��• Q,��,-�.5� '�,,�CEE��.�` TAX LOT , PLS L-3063 1W0 NEW LOTS TAX PARCEL � 1 � ' � , , DAVIE COUNTY HEALTH DEPARTIVIENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001132 Tax PIN/EH#: 5768-87-7795.02 Billed To: E. Kent Walser Subdivision Info: Reference Name: Kent Walser Location/Address: Mohawk Lane-27006 Proposed Facility: Residence Property Size: 1.50 Acres Date Evaluated: t��/D —�C _'_"„� Water Supply: On-Site Well Community Public Evaluation By: Auger Bori Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition L �_ S10 e% pa 3 HORIZON I DEPTH — — (7 Texture rou Consistence 5 Structure Mineralo � ' ; HORIZON II DEPTH — Texture rou �- Consistence S�.S � Structure Mineralo ' ' ` 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 0 SITE CLASSIFICATION: �� EVALUATION BY: �� `""�� LONG-TERM ACCEPTANCE RATE: o OTHER(S)PRESENT: REMARKS: ��< '� �61-tX� 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 tructure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogv 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)