260 Macy Langston Ln DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name Date /,
Location :1 \ �; 1 � '� `'" a�D ?�,/ [�+"
�A
t
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES p NO �� Specifications for System:
Auto Dish Washer YES p." NO E] f., -,
Auto Wash Machine YES p- NO p , t
Type Water Supply C., �. Y' ..>
; ``
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
r 1
r. .
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by �� <`� �
1190
Certificate of Completion Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT 9
Davie County Health Department 10
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
tHome Phoned 63#-- 7-3/�
1. Permit Requested By Bus' ess Phoh3z- /3 7 3
2. Address Qe
3. Property Owner if Different than Above
Address /
4. Permit To: a) Instally Alter Repair
b) Privy Conventional—!!!f Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home—Business
Industry Other
b) Number of people Z-
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions �L X V/
Bed Rooms Bath Rooms_ Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water-using fixtures:
commodes urinals garbage disposal
lavatory / showers washing machine
dishwasher sinks
8. a) Type water supply: Public ? Private Community
b) Has the water supply system been approved? Yes No r/
9. a) Property Dimensions
b) Land area designated to building site _74 -�
C) Sewage Disposal Contractor A"e,tx 1L V_",.9
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
Dat - Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
AkA
DCHD(6-82)
` i
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
\ , SOI SITE EVALUATION
Name v Date v 3
Address Lot Size
FACTORS AR 1 A116i) AREA 3 AREA 4
1) Topography/Landscape Position pS PS
U U
U
2) Soil Texture (12-36 in.) Sandy, S S
Loamy, I (note 2:1 Clay) Q& PS PS
U U U U
3) Soil Structure (12.36 in.) C� S S
Clayey Soils PS PS
U �"" U U
4) Soil Depth (inches) � <� --� S S
PS PS
U U U U
5) Soil Drainage: Internal S S
PS PS
ZT' U U
External S S
PS PS PS
U U U U
6) Restrictive Horizons
7) Available Space S S
C P PS PS"
� U U U
8) Other (Specify) S S S S
PS -PS PS PS
U U U
9) Site Classification
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by \- Title Date
SITE DIAGRAM
/ 1
DCHD(6-82)
1 L _
Parcel#: D30000003603 Page 1 of 1
Davie County, NC - Basic Estate Search �,ou��,,
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Parcel#:D30000003603 Account#: 22182000
Owner Information Tax Codes
[60
LL VERNON ADVLTAX-COUNTY T
MACY LANGSTON LANE FIREADVLTAX-FIRE TAXCKSVILLE NC 27028
Property Information Township
�ddre(X:1260
ts/Type): 55.900 AC CLARKSVILLE
MACY LANGSTON LN
Deed Information Local tonin
ate: 05/2007 Book: 00715 Page: 0366
lat Book: 0005 Page: 136
Legal Description PIN
55.92 AC E OFF HWY 601 LIFE ESTATE 5822363420
Propertv Values
Buildln : 224,91
BXF:
Land• 194,38
Market: 419 29
ssessed: 257,22
Deferred: 162,07
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00128 0684 10 1985 WD Unqualified Vacant 0
00709 0632 04 2007 WD Unqualified Improved 0
00715 0366 05 2007 WD Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bili Information
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All information on this site is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds,
plats, and other public records and data. Users of this data are hereby notified that the aforementioned public Information sources should be
consulted for verification of the information. All information contained herein was created for the Davie County's internal use. Davie County,
Its employees and agents make no warranty as to the correctness or accuracy of the Information set forth on this site whether express or
Implied, in fact or In law, including without limitation the Implied warranties of merchantability and fitness for a particular use.
If you have any questions about the data displayed on this website please contact the Davie County Tax Office at(336) 753-6120.
1.5.9
http://maps.daviecountync.gov/itsnetfView.aspx?prid=1473658 8/10/2016