446, 474 or 478 Jack Booe Rd (2)-
_
DAVIE COUNTY HEALTH DEPARTMENT
yI IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
�"i
Name —`a /�, �g Date �� � NO 7 5 -7 2
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _T Business _— Industry
No. Bedrooms No. Baths No. in Family 3 — Public Assembly Other
Garbage Disposal YES ❑ NO 2— Specifications for System:
Auto Dish Washer YESNO E]/DDS
Auto Wash Ma thine YES �j NO ❑
Type Water Supplyzl
`~ 'This permit Void if sewage system described below is not installed within 5 years from dale of issue.
This permit is subject to revocation if site plans or the intended use change.
00
r
Improvements permit by
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*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by 1-onh-. .4- Lak<1/
S -k P �l i
dc'L. fi b~
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
' Davie County Health Department
(� l� Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
KJ'�'4PtfFTCe Phone % '7 (F— YS %D
-~- Y/7l, /y. � Business Phone
1. Permit Requested By 6 hy 6. L,,c G N c, .�%
2. Address fl t A & c vi% e , �7
3. Property Owner if Different than Above L v a"5- % )-L
Address W Slow fle<1,IX L✓ -S,
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type—
Ground
ype Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. a) Ik house or mobile home, state size of home and number of rooms.
House Dimensions / r00 G% *'
Bed Rooms r 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:
n_
commodes
lavatory
urinals
showers
2
dishwasher l sinks 3
8. a) Type water supply: Public Private ✓ Community.
b) Has the water supply system been approved? No tZ
9. a) Property Dimensions / 7 A-cR,e -
b) Land area designated to building site
c) Sewage Disposal Contractor
na
garbage disposal
washing machine
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? /yb•
What type?
This is to certify that the information is correct to the best of my knowledge.
- '�_ " S % A
Date V Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: �
o 7-0 V %% c �` l
DCHD (6-82)
E
Address
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date
Lot Size 6
FAC:Tr1RC APPA i ARFA 9 AREA 3 AREA A
t) Topography/ Landscape PositionS
P5
&
M
S
PS
U
E
Address
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date
Lot Size 6
FAC:Tr1RC APPA i ARFA 9 AREA 3 AREA A
t) Topography/ Landscape PositionS
P5
&
S
PS
S
PS
U
U
U
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
P
/ '�
S
PS
S
PS
U
U
U
3) Soil Structure (12-36 in.)
Clayey Soils
S
P
S
PS
U
S
PS
U
t) Soil Depth (inches)
T
S
PS
U
S
PS
U
i) Soil Drainage: Internal
p
b�
S
PS
U
S
PS
U
Externall
g
l'Sj
S
PS
U
S
PS
U
i) Restrictive Horizons
Available Space
`S
PS
VS
S
PS
S
PS
U
U
U
U
I) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
q Site Classification
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/ Comments:
Described by
SITE DIAGRAM
DCHD (6-82)
" Davie County AAK Department
and .dome Neall 0yency
210 HOSPITAL STREET / P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634-5985
Tony Buchanan
Rt. 2, Box 216-A
Mocksville, NC 27028
November 12, 1987
Re: Site Evaluations (3)
Jack Booe Rd.
Mr. Buchanan:
On November 6, 1987, this office evaluated three acreage tracts at your
request on Jack Booe Road in Davie County.
All three tracts evaluated are classified provisionally suitable for
septic tank systems.
When your house is staked off, please contact this office, and we will
reevaluate the site and issue a septic tank permit.
Sincereelyyy,,
&Y
ID
Robert B. Hall, Jr., R.S.
Environmental Health
RH/wd
Enclosure