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139 Bugle Ln� �,r• r�r-,�z � > � � ' t'• < t'` . e ... ' , � :'t ,,T J,� � , � _ }`� 4.' ';.. .m r . � • � —.. r 3 XU DAVIE COUNTY HEALTH DEPARTMENT .�I IMPROVEMENTS PERMIT AND. CERTIFICATE -OF COMPLETION - r *NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a Sanitary Sewage Systems Permit Number , T lDate - �) -NamN2 6 Locatio ///,`f (//`"^-l/r�.�.r�✓ Jr�-^J?�•l %, �'% -� /� r' " Subdivision Name Lot No. Sec. or Block No. Lot Size =Z!:!22 i'�- House i Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family ::? Garbage Disposal YES ❑ NO p-`" Specifications for System: Auto Dish Washer. YES [a-- NO ❑ leg e) ol Auto Wash Ma ,hive YES p' NO ❑ Type Water Supply *This,permit Void if sewage system described below is not installed within 5 years from date of issue. This�permit is subject to revocation if site plans or the intended use change. 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 byV"lf,4• �— Certificate of Completion Date _Z .*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 Davie County Health Department Environmental Health Section P. 0. Box 665 REC&WD APR Mockoville, NC 27028 i 1. Application/Permit Requested (�By,` Mailing Address kI b-64wt o, I'�d`' ance N c Home Phone NO qK- MIA Business Phone (91q) V-Gg4D 2. Name on Permit if Different than Above a.a I SM r 3. Property Owner if Different than Above 4. Application/Permit For: 0 General Evaluation S/Tank Installation S. System to Serve: House 0 Mobile Home 0 Business 0 Industry u Other 0 Unknown 6. If house, mobile home. Subdivision Sec.Lot# No. of People Dwelling Dimensions q9 X 40 No. of Bedrooms J 0 Basement/Plumbing No. of Bathrooms Basement/No Plumbing Washing Machine , Dishwasher, 0 Garbage Disposal 7. If business, industry, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers 8. Type of water supply: Public r 9. Property Dimensions 10. Sewage Disposal Cont No. of Sinks No. of Urinals No. of Water Coolers 0 Private -- 0 Community CUN 11. Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes �No If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. This is to certify that the information provided is correct to tree best of my knowledge, and I understand I am responsible for all charges incurred from this application LI -91` Dateignature Directions to Property: Ke- J1xL 6 0l Al , g v apprd yiinak �� n��es GF,Ie/c�c e�n�c � 0 ve-K # Z -`%r Go Pct, W In R D' -4 Vi"f qnd Nc X -� r.yd Ce /✓ f' b -b l Lt, -n CC(j Lul) 9 ra vef 4�✓i VC' �c/ and eo t i it s id e a%, Wires q AM �,� P P � P , �F r-&� Mhz pro v r4z , � r -Jur/7 do,14 be�s1 d,� � 1) s�ci�l� 9 DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT y ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED (office use only) (�e:s no 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of the abovedescribed property, however, I certify that l have consent from owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for. a, ground absorption sewage treatment and disposal system. yes no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. D E SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: Owner only Owners designated representative —Anyone requesting results _ Only those listed below AT SIGNATURE DCHD (11 /84) r DAVIE COUNTY HEALTH DEPARTMENT I l :♦ Environmental Health Section S o'1/Site Evaluation f NAME ' DATE EVALUATED ADDRESS PROPOSED FACIILTY PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L I. L .- - . L -- Slope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH I" Texture group 0— . Consistence -� Structure % S S•Z Mineralogy / r•-" HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION i LONG-TERM ACCEPTANCE RATE y SITE CLASSIFICATION: '�> I LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-901 EVALUATED BY•�� 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 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 Mineralosts► 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 ■O■■ ■OE■ ■EM■ OMEN ■OM■ Parcel #: E30000006503 Dayie County, NC - Basic Estate Search basic Search Real Estate Search Tax Bill Search Sales Search 0 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: E30000006503 Account #:71085000 Owner Information Property Building: Tax Codes BXF: TEWART EMILY GAIL SMITH Land: ADVLTAX - COUNTY T �FIREADVLTAX Market: 139 BUGLE LANE ssessed: - FIRE TAX Deferred: MOCKSVILLE NC 27028 Property Information Township nd (Units/Type): 0.000 CLARKSVILLE ddress: 139 BUGLE LN Deed Information Local Zoning Date: 11/1989 Book: 00151 Page: 0607 Plat Book: Page: Legal Description PIN .� 5.00 AC HWY 601 821-06-8891- 71085000 5821-06-8891- Pro a Values Building: 200,00(1 BXF: 24,02CI Land: 36,52 Market: 260 54 ssessed: 260,54 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00151 0607 11 1989 WD Qualified Vacant 14 000 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 047 " °t Davie County Web Site 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/itsnet/View.aspx?prid=749353 8/23/2016