6778 Hwy 801SAccount #: 990001314
Billed To: Brian Angus
Reference Name:
Proposed Facility: Residence
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Tax PIN/EH #: 5746-84-3694
Subdivision Info: 5'
Location/Address: Huey 8014-27028
Property Size: 6 acres
ATC Number: 2518
**NOTE** This 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 _eg%Tl #People 4_ #Bedrooms #Baths 0)—_
Dishwasher: Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industri 13al Waste:
Lot Size Type Water Supply Q6 Design Wastewater Flow (GPD) .,2�61 Site: New EI/Repair ❑
System Specifications: Tank Size_ GAL. Pump Tank
Other:
Required Site Modifications/Conditions:
r -
GAL. Trench Width Rock Depth Linear Ft.Y
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 K BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
- -2j�
Environmental Health Specialist's Signature: _ p� V %� Date: 2S /l/
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001314 Tax PIN/EH #: 5746-84-3694
Billed To: Brian Angus Subdivision Info:
Reference Name: Location/Address: Hwy 801.V.-27028
Proposed Facility: Residence Property Size: 6 acres
ATC Number: 2518
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATER C S UCTION IS VALID OR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: 0 Iaa�
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation 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.
u
AD'
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
/to
Date:`
IF FOODSERVICE: # seats Estimated Water Usage (gallons per day)
7. Type of water supply: W ounty/City 0 well O Community
9. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yes p -No'-
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMI77ED by the client with THIS APPLICATION.
Property Dimensions: 6 r-kt' WRITE DIRECTIONS (from Mociaviile) to PROPERTY:
Tax Office PIN: # "' t " re 4r -x ke
Property Address: Road Name - --6�)�-� ►"11 %.� lri'C S
City/Zip/'�T'�C! SSV i Re- - - - - 11 Yl�e P�
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot:
Date Property Flagged:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
Issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed 1, also, understand that I am responsible for all charges incurred frons
this application. I, hereby, give cousent to the Authorized Representadve.of the Davie County Health Department
to enter upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site suitability.
DATE "MINI[Wi,1 lf F-;-VWI_&L;0WQ
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site. Revisit Charge
I Date(s):
I Client Notification Date:
l EHS:
�-
v
e� 5 +*- �
Revised DCHD (07/99)
Account No.�
Invoice No. 5 1 'r►+ �'t
Ce
'
J-9 R
APPUCATION FOR SITE EVAUTATION/IMPROVEMENT PERMIT &
I �W
Davie County Health Department
Environmental Health 5L, -Won
AUG - 4 2000
P.O. Box 848/210 Hospital street
Mocksville, NC 27028
(336) 751-8760
ENVIR01% RENTAL HEALTH
DAVIE COUNTY
***IHP0RTANT***
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION Is
PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1.
Nage to be Billed
Contact Berson
&W ANO (A Contact
!^� i
Mailing Address
O �, � �l�S/�I lJl IC(' Rome Phone
City/state/LIP
0� `�7 V Nl , Q�O Business Phone q0q - L6 1-5
+ 161-5
2.
Name on Permit/ATC
if Different than ]Above
Mailing Address
City/stag/Lip
3.
Application For:
❑ site Evaluation ❑ Improvement Permit/ATC eBoth
WHouse
4.
System to service:
bile O Industry ❑Other
LJ
b.
If Residence:
# People # Bedrooms# Bathrooms
0 Dishwasher n
Garbage Disposal 0 washing Machine W-19"ement/Plumbing 0 Basement/No Plumbing
6.
if Business/industry/Other: specify type # People # sinks
# Commodes
# showers # Urinals # water Coolers
IF FOODSERVICE: # seats Estimated Water Usage (gallons per day)
7. Type of water supply: W ounty/City 0 well O Community
9. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yes p -No'-
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMI77ED by the client with THIS APPLICATION.
Property Dimensions: 6 r-kt' WRITE DIRECTIONS (from Mociaviile) to PROPERTY:
Tax Office PIN: # "' t " re 4r -x ke
Property Address: Road Name - --6�)�-� ►"11 %.� lri'C S
City/Zip/'�T'�C! SSV i Re- - - - - 11 Yl�e P�
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot:
Date Property Flagged:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
Issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed 1, also, understand that I am responsible for all charges incurred frons
this application. I, hereby, give cousent to the Authorized Representadve.of the Davie County Health Department
to enter upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site suitability.
DATE "MINI[Wi,1 lf F-;-VWI_&L;0WQ
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site. Revisit Charge
I Date(s):
I Client Notification Date:
l EHS:
�-
v
e� 5 +*- �
Revised DCHD (07/99)
Account No.�
Invoice No. 5 1 'r►+ �'t
Ce
Ul
Sl
�r
.6746
67
Fr
`73
67 9 4
EE
68 0 2 �x
683:8
2
r
4680''
FACTORS 1 2 3 4 5 6 -. 7
Landscape position L S
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
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
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: EVALUATION BY: �` 4
11
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: -
REMARKS:
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
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION
PROPERTY INFORMATION
Account #:
990001314
Tax PIN/EH #:
6746-84-3694
Billed To:
Brian Angus
Subdivision Info:
Reference Name:
Location/Address:
Hwy 801,S-27028
Proposed Facility:
Residence
Property Size: 6 acres Date Evaluated:'—� 71(�
Water Supply:
On -Site Well
Community
Public
Evaluation By:
Auger Boring
Pit ! /
Cut
FACTORS 1 2 3 4 5 6 -. 7
Landscape position L S
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
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
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: EVALUATION BY: �` 4
11
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: -
REMARKS:
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
DCHD 05/99 (Revised)
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Parcel #: L50000007802
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bili Search Sales Search +�
Vlew Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #:L50000007802
Account #:82517426
Owner Information
BXF•
I Tax Codes
nd:
GUS BRIAN TIMOTHY& ANGUS HOLLY D
[778
Market:
ADVLTAX - COUNTY T
ssessed:
NC HIGHWAY 801 SOUTH
eferred:
READVLTAX - FIRE TAX
CKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 5.560 AC
JERUSALEM
[Address: 6778 S NC HWY 801
Deed Information
Local Zoning
Pate: 08/2001 Book: 00385 Page: 0367
Plat Book: Page:
Legal Description
PIN
5.934 AC NC HWY 801 S
5746843694
Property Values
uildin :
219,88
CCC
BXF•
15,79
nd:
39,99
Market:
275,66C
ssessed:
275 660
eferred:
91
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 00339 0945 07 2000 WD Unqualified Vacant 11,000
! 00385 0367 08 2001 WD Unqualified Vacant 0
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
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a�f�41%
1
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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/itsneWiew.aspx?prid=1460775 8/24/2016