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127 Macy Langston Lne g ';p t r.t.., .',n•c...'4.: '"o .:?>" 4 '_a..` r.:-.,y,).=;r. f, ,. `,, .. - :. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND . CERTIFICATE OF COMPLETION *NOTE:='Issued in Compliance With Article II of G.S. Chaptq 130a " Sanitary Sewage SystemsT� • iioWi>' Permit Number r � >> �. err Name ._ ,.�., ;w=... �� �.� ; �_ Date N2 6768- Loc 7 ULoc do Subdivision Name Lot No. Sec. or Block No. Lot Size ,�•�� �' House_ Mobile Home _T Business Speculation No. Bedrooms No. Baths_ No. in Family Garbage Disposal YES NO ❑ Specifications for System: Auto Dish Washer YES NO ❑ Auto Wash Ma shine YES NO ❑ ���`��Y / 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. Improvements permit by 1Z '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 C — — — — Certificate of CompletionDate `The signirig 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.{ 0 1 1. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME 4ZryJ � c ADDRESS PROPOSED FACIILTY Water Supply: DATE EVALUATED &rV -�;� PROPERTY SIZE LOCATION OF SITE On -Site Well Community Public Evaluation By: Auger Boring L/ Pit Cut FACTORS 1 2 3 4 Landscape position Slope % — - — HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH Texture group (11e C Consistence {: Structure Mineralogy /. / /. /, HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION T S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: r_ 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 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 -Prismatic Mineralogy 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 ■■M■ OMEN ■■■■ ■ON■ ■ON■ ■■■O■■ ■EMEM■ . - APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Perm Mailing Address Home Phone�2dL2?-`Z5 de Business Phone 912 -92d -c-2,191 2. Name on Permit if Different than Above /oDlC 3. Application/Permit for: ❑ General Evaluation Septic Tank Installation 4. System to Serve: I# House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If house, mobile home: Subdivision No. of People 19, No. of Bedrooms No. of Bathrooms Dwelling Dimensions l3Sa��r. 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers 7. Type of water supply: Public 8. Property Dimensions No. of Sinks No, of Urinals No. of Water Coolers Water Usage Figures ❑ Private Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what'type? ❑ Place of Public Assembly ❑ Unknown Section Lot # ❑ Basement/Plumbing Basement/No Plumbing Washing Machine Dishwasher Garbage Disposal ❑ Yes P(No ❑ Community '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. Directions to Property: 00/ '_- �r/i�a�e /vQd ©r! �"/ghz� t!/qsL� IOQCl� 0/? /'IVh beiare ` 0CJ ,8cpe. 4oao1 ). v Please C017Z-C,e� ,6oh /,einm017S )C01- This or This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. X/ DATE I r SIGNATURE CONSENT O .6JN EVALUATION TQ .R9 DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the=C �C9unty He I h Departme t to enter upon above described property located in Davie County and owned by J �l�C� ,C �21 1O,-� to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE - - , '*-"NATURE DCHD (12.90) Parcel #: D30000003605 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search 0 View Property Record -for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: D30000003605 Account #:37689250 Owner Information Tax Codes ADVLTAX - COUNTY T riREADVLTAX - FIRE TAX HOWARD TODD L& LEMMONS KIMBERLY A 127 MACY LANGSTON LN OCKSVILLE NC 27028 BXF• 38,30( Property Information Township F- Land (Units/Type): 5.000 AC [Address: 127 MACY LANGSTON LN CLARKSVILLE ssessed: 203,32( Deferred Deed Information Local Zoning Pate: 12/1992 Book: 00166 Page: 0501 Plat Book: Page: Legal Description PIN 5.00 AC HWY 601 5822163892 Property Values Building: 11189 BXF• 38,30( Land: 53,13( Market: 203f32( ssessed: 203,32( Deferred Sales Information No. Book 1 00166 Page 0501 Month Year Instrument Qual/UnQual 12 1992 WD Unqualified Improved Price Vacant 0 View Property Record for this Parcel View Map for this Parcel View Tax BIII Information « Return to Basic Search Page 1 of 1 vP�f� �OUA. N� A: 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=1478562 8/17/2016