942 Angell RdDavie County, NC , T� Parcel Report Wednesday, October 12, 2016
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: F40000004701 Township: Farmington
NCPIN Number: 5831933437 Municipality:
Account Number: 48912000 Census Tract: 37059-806
Listed Owner 1: MCCULLOH HAL THOMAS JR Voting Precinct: FARMINGTON
Mailing Address 1: 942 ANGELL ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag. District: No
Legal Description: 93.373 AC ANGELL RD Fire Response District: WILLIAM R. DAVIE
Assessed Acreage: 90.62 Elementary School Zone: WILLIAM R DAVIE,PINEBROOK
Deed Date: 8/2006 Middle School Zone: NORTH DAVIE
Deed Book / Page: 2006E0288 Soil Types: MrC2,MrB2,GnB2,EnB,MsC,ChA
Plat Book: 9 Flood Zone:
Plat Page: 138 Watershed Overlay: DAVIE COUNTY
Building Value:
Land Value:
Total Assessed Value:
294080.00 Outbuilding 8� Extra 1470.00
Freatures Value:
269470.00 Total Market Value: 565020.00
333530.00
9Rim�A Davie County,
�o��,�� NC
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Davie County Health Department
q�i sr�' Environmental Health Section
� � � P.O. Box 848 da�e.
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� �,�,. .���/ 210 Hospital Street �e�e.
C`} �, „��fv1 `�v"> Courier # : 09-40-06 �`"�'6 , 3D
� � � ��� Mocksville, NG 27028
Phone: (336) - 753 - � \ �t � l � e� C�
(336) - 753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection q l�� -���G�
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Name: �!-�`'1�-�= ��"" Phone Number � f�J ' �7 �'' ��Z � (Home)
MailingAddress: � �� �-`�sh-!�„�� C� (Work)
/� !/g-^" �� �✓�- 2 � '' ' v Email Address:
Detailed Directions To Site:
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�� a-� ���'`� '�' ��� � �� � E / /� 2:
Please Fill In The Following Information About The EXISTING Facility:
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Name System Installed Under: � c`� � �L. CCti <`4 � Type Of Facility: .� �/. f""`"' �
Date System Installed (Month/Date/Year): �� ll� '�`� Number Of Bedrooms: 3 Number Of People: �
Is The Facility Currently Vacant? Yes � If Yes, For How Long?
Any Known Problems? Yes I�o If Yes, Explain:
Please Fill In The Following Information About The NEW Facility:
T e Of Facili ��" �''� 3°�� Z �
yp ty: ��� j�Number Of Bedrooms: Number of People
. �. �
Pool Size: � ���� ge Size: Other: 1�.� f r �,S _
Requested By:
_Date Requested:
;�'�~` . For Environmental Health Office Use Only
Approved�isapproved n n _ , /1 � „ /.
Comments:
Environmental Health Specialist
Date: � �(� �,S
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
�(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment:
Paid By:_
Account #:
Money Order #
Amount: $
Received By:
Date;
voice #:
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Davie County Health Department
Environmental Health Section
P.O. Boh 848
210 Hospital Street
Courier # : 09-40-06
Mocksville, NC 27028
Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680
(Check One) Replacement Remodeling Reconnection
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Name: � �J � �- � d � ��z �'y!� Phone Number �36 . 5'�0 • /J �� � (Home)
MailingAddress: �3l �/t,r/L•l,�c %"���-$/��7 (Work)
� ���^``�^�-- i Email Address:
Detailed Directions To Site:
Property Address:
�
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: � / �/�', �,t,�lLO �'1 Type Of Facility: -r� � � '�, �
Date System Installed (Month/Date/Year): �^�O �t� � Number Of Bedrooms:� Number Of People.
Is The Facility Currently Vacant? Yes � If Yes, For How Long?
Any Known Problems? Yes � If Yes, Explain:
Please Fill In The Following Information About The NEW Facility:
Type Of Facility: � hC�Q� ���(rri.. ��..��lL Number Of Bedrooms: Number of People
Pool Size:
Requested By:
(Sig ature)
pproved Disapproved
Comments:
Environmental Health Specialist�
Garage Size: Other:
� Date Requested: � 3 �
For Environmental Health Office Use Only
Date:
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cash ( Check��Nloney Order #
Paid By:
Received By:
Account #: I �iZ �0 Invoice #: V v ,�sc,'j�C%
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l�avie C�ounty Health lleparhnent
�s j�_: :� "�,;�" : . Environmental Health Section
. � � � ' P.O. Box 848
� �''�,5,,= � 210 Hospital Street
U �'t �! � ' Courier # : 09-40-06
- Mocksville, NC 27028
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Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFIC�ITION ;.: i. FaX: (336) - 753-1680
�':' - (Check One) Replacement Remodeling � Reconnection `�' '
� � ! L� d a : .. � ��Y/,'-'� �
Name: �� CC� �J l� �- � vI� ��z GLc °�1:9 Phone Number ��� ��c� • ��! yC�(Home)
Mailing Address: / � � L`l�S �- � „/ r C � �� - � y� 7 (Work)
�� `� ��-� ''���— � Email Address:
Detailed Directions To Site:_ /� �1i1 �'�f 4 /-Z �� � �•�� k/ ,.�fJ �2 ''c��f
Property Address:
✓
Please Fill In The Following Information About The EXISTING Facility:
y v� T e Of Facili �`� -� ��-. �/
Name S stem Installed Under: �[: � U�� l� yp ty: .S'' �
Date System Installed (Month/Date/Year): ���O ��(J :. Number Of Bedrooms� Number Of People. ,
Is The Facility Currently Vacant? Yes ��' If Yes, For How Long?
Any Known Problems? Yes '�� If Yes, Explain:
�
Please Fill In The Following Information About The NEW Facility: ,
{ ,,: �»...,.
Type Of Facility: r)1' t U L_' i'1 , (��L Number Of Bedrooms: Number of People
Pool Size: " �. Garage Size: Other.
i.� � � ,�---�,_,.��:r
Requested By: �%,./ --� ;�� ! F-�"'''A Date Requested: ��
(Signature) /
'� For Environmental Health Office Use Only
�'t�pproved Disapproved
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Comments:
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Environmental Health Specialist�t: c�/�i �i � c�' � �1�-! // �l
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Date:
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*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
_ � —t-- _ _ _
Payment: Cash Chec�Money Order # ��; �' � � Amount:$ � v Date: � � c3-
�+ ' � �
Paid By: � � ; ,._.,,, Received By: � "�
Account #: �`�i7 �U Invoice #: � ;��% G]
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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 (1 o NCA . . .__. _._ Permit Number
Na e —
�
� ocation
� _ Date ^
�� * F - ; . _ . „� , � ,, t.. . �n �'��
, `'-`_.___.._ _._._..� - _
Subdivision Name Lot No. _ � Sec. or Block No.
Lot Size —_ _ House _.1L—__ Mobile Home ____ Business _--_ Speculation
No. Bedrooms �_ No. Baths �__ No. in Family �_
Garbage Disposal YES ❑ NO ❑ S ecifications for System:
Auto Dish Washer YES ❑ NO ❑ ��� Q�� ��y, �_��X
Auto Wash Machine YES ❑ NO ❑ �O � �9 � � � �
Type Water Supply _ ________
'This permit Void if sewage system described belaw is not installed within 36 months from date of issue.
� �
�
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:
.
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.
.
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� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department�; •
Environmental Health Section
P. O. Box 665
, Mocksville, N.C. 27028
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CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone `3 9�� 3 7 S' �
1. Permit Requested By ��11`rl i e �C l� vc,/�o !� Business Phone
2. Address 6�a ��� iV%�a c�lsdi/�r _� 7 0� S''
3. Property Owner if Different than Above
Address
4. Permit To: a) Install �r Repair
b) Privy Conventional�her Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House r-�Mobile Home Business
� Industry Other
b) Number of people ✓
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
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 hou
7. Number and type of water-using fixtures:
commodes
lavatory _
dishwasher
urinals
showers
sinks
garbage disposal
washing machine
8. a) Type water supply: Public Private ✓ Community
b) Has the water supply system been approved? Yes No �
9. a) Property Dimensions ����' ''
b) Land area designated to building site a0l�C�
c) Sewage Disposal Contractor
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 k�n �iledge.
� � /��
o2%?D/�'7 C-�,
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPL ANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: �
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DCHD (6-82)
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' ' DAVIE COUNTY HEALTH DEPARTMENT ' '
Environmental Health Section �
P. O. Box 665 �
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name � �` �� Date �^�� `��
Address Lot Size a � ��"�
1) Topography/Landscape Position
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
3) Soil Structure (12-36 in.)
Clayey Soils
4) Soil Depth (inches)
5) Soil Drainage: Internal
External
6) Restrictive Horizons
7) Available Space
S) Other (Speciry)
9) Site Classification
Recom
U—UNSUITABLE
ions/Comments: w '�N`
c�...s,
Described by _
SITE DIAGRAM
OCHD (6-82)
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S—SU�TABLE
AREA 2
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PS
U
PS
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PS
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PS
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US
PS
U
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PS
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PS—Provisionaliy Suitable
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AREA 4
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PS
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PS
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PS
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Title ""'� a Date � ��y � ��
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�tti�tP (�vun#� �PttI#1� �e�ttr#men#
�tLt� �DtttP �EtYI�I� ��81tt�1
P. O. BOX 665
�fCac�si�ille, �durtl� (t�ttrolinn z7IIz8
OFFICE OF THE DIRECTOR
February 25, 1987
Mr. Tommie McCulloh
Rt. 6, Box 84
Mocksville, NC 27028
�'M
Dear Mr. McCulloh:
t ;
As you requested, a representative from this office visited
your site on Angel Road and has determined the soil suitable for
the installation of a ground absorption sewage system. If you
have any questions, feel free to call this office.
Sincerely,
Charlie Little, R.S.
Environmental Health
Enclosure
TELEPHONE .
f7041 634 •5985