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865 Ben Anderson Rd DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900103 Tax PIN/EH#: 5803-31-6892 Billed To: Joey Cline Subdivision Info: Reference Name: Location/Address: 865 Ben Anderson Road-27028 Proposed Facility Residence Property Size: 325 x 700 ATC Number: 3921 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 I 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRU TION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 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 1 I 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. A Septic System Installed By: 61A A r A Environmental Health Specialist's Signature: Date: -711 DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT I ,7 Environmental Health Section '`L (L P.O.Boz 848/210 Hospital Street ` / Mocksville,NC 27028 /� (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900103 Tax PIN/EH#: 5803-31-6892 Billed To: Joey Cline Subdivision Info: Reference Name: Location/Address: 865 Ben Anderson Road-27028 Proposed Facility Residence Property Size: 325 x 700 ATC Number: 3921 **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 / #People ,? #Bedrooms .1 #Baths -0, Dishwasher: Garbage Disposal: ❑ Washing Machine:;? Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) ��d Site: New• Repair❑ 07 el System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth IaZ Linear Ft-OD Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 11 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.**** I" Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) D ECEOWEAI CATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Health Department Environmental Health Section NOV 5 2004 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 I]WRONMENTAL HEALTH PLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Contact Person Mailing Address y Ic/ (/ / /-P-Jc L L Home Phone �)�lp ��2 City/State/ZIP _T O(k)yiI 44 -7O?il Business Phone �2- ^l 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both 4. system to service: ( House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: Conventional ❑ conventional modified ❑ innovative 6. if Residence: # People _ # Bedrooms _ — # Bathrooms ❑Dishwasher ❑Garbage Disposal [&ashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: ❑ County/City Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes No If yes,what type? 'IMPORTANT "CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: - X -160 WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # () C) /VO' ?o L;,b �i� ���,v Property Address: Road Named Y City/Zip OLIriji c27- f 6(4 h�-sum. l ?/-• '/cs If in a Subdivision provide information,as follows: Name: Ali Section: Block: Lot: Date home corners flagged: (��P-N -- � J This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(:) 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. I,also,understand that I am responsible for all charges incurred frons this application. I,hereby,give consent to the Authorized Representative 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. J J DATE (� b / SIGNATURE THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN(Include of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Cc� Datc(s): Ld Client Notification Date: EHS• l Sign given �� Account No. o© 0 3 Revised DCHD(05/03 Invoice No. 7� �� {{{�r a,3"br i> ,�;,�4 r•;+��,. tirsa3 w.ti :z .A.{iW+a.r f-s„ €, rasa-wri '"+ `AUT- RORIZATIQN NO DAVIELINTY HEALTH DEPARTMENT 1: {Environmental Health Section PROPERTY INFORMATION Perme'ti P.O.*Box 848 Mocksville,NC 27028 Subdivision Name: r� ,! a Phone# 336-751=8760 Directions to property: S iii t���'�fi e� ' . 'Section- Lot: AUTHORIZATION FOR f WASTEWATER Tax Office PIN:#,, �. . SYSTEM CONSTRUCTION -p — Road Name: " 1): dv r **N,OTE**This Authorization for Wastewater System Construction MUST BE ISSUED,by the Davie County Environmental Health Section prior to issuance of any Building-Permits.This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) 77r ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. r. ENVIRONMENTAL HEALTH SPECIALIST:, DATE ISSUED � .. i e�yy ♦s+�4 ka i{:;w *v+s:r t ..._+:. .r.y..,.zw ui``-.. 'ti*� -i>a�:y`.t.i'",4".w r.-�;'�W�Y>,."iFdd'`sa�'.".,-;.� K .+*G.xl!`�-.w �c:�.�•iwr+c�"'a,.ra.diw....'y.-+s a�'v1H^Hnf'. `16 71 DAVIE COUNTY HEALTH DEPARTMENT 'IMPROVEMENT.AND OPERATION PERMITS PROPERTY_INFORMATION ' Porn% •e >:Na�rie: r_ 1' Subdivision Name Direct o s ta�property: �'� G, ( l o" Section: Lot:: MWROVEMENT ' PERMIT Tax Office PIN:kr4gL' - +✓ . Road Name ) .. 1p Ie r� **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank�syste'm or any wastewater system.An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construc6on/mstallation of a system or the issuance of a building permit., S (U►compliance With Article 11 of G.S.Chapter 130A'Wastewater Systems, ection.1900 Sewage Treatment and Disposal Systems) i ***NOTICE***THIS PERMIT IS SUBJECT.TO REVOCATION IF SITE ' PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL-HEALTHSPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT,BEFORE ...: ;INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION.BU , ILDING TYPE #BEDROOMS #BATHS e #OCCUPANTS, GARBAGE DISPOSAL:Yes or No ' COMMERCIAL SPECIFICATION: FACILITYTTYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE 114/9C TYPE WATER SUPPLY_ DESIGN WASTEWATER FLOW(GPD) NEW SITE. REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZEl_y GAL. .PUMP TANK- GAL. TRENCH WIDTH 3� ROCK DEPTH_ LINEAR FT.Z�a OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT ' **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 THE DAY OF INSTALLATION:TELEPHONE#IS (336)751-8760.: OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "THE ISSUANCE OFTHIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 05/96(Revised) 1: 7 .. .,w.� �r'!". - �' ,^e"—o3W.-^ii •��,.4 . ..1._...J1p., • '- "�*"r ' 7 1 DAVIECOUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITSPROPERTY INFORMATION , Name '` ) 1 / Subdivision Name: Directio s'to property:'~ '""'.µ' r f" t . Section: Lot: IMPROVEMENT j i PERMIT Tax Office PIN:"' <�%'l - Road Name �7 i' ,� 2 mZ p:WL **NOTE**This Improvement Permit DOES NOT authorize the construction or installation 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) ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ' a SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE " ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED . INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS_. #BATHS jQ #OCCUPANTS"_S' GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE - #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW,(GPD) 7?/,!g U NEW SITE REPAIR SITE i SYSTEM SPECIFICATIONS: TANK SIZEly GAL. PUMP TANK 16:A�j_AENCH WIDTH ROCK LINEAR LINEAR FT. < " OTHER f REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT r` '*CONTACT A REPRESEN((TAT iNE 0 THE D VIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 :30,rA!M.OR 1:00-1. 0 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760. OPERATION PERMIT fo6YSTEM IN$T'ALLED BY: y : AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE in 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. DCHD 05/96(Revised) ,. 171 /(rr i APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&A �� Davie County Health Department U .VIP Environmental Health Section nq P.O. Box 848/210 Hospital Street Ju- 3 Mocksville, NC 27028 q► (336)751-8760 IRONME HEALTH �VVJ DAVIE C NTY ***ZWORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed V 'e `n // "� Contact Person ��/r/�/ C 9f Irk x- Hailing Address e q� C(7ec /1 Jrch Home Phone City/state/ZIP M 0 t s)JI'S AC 2 0 Business Phone S k" C- 2. 2. Name on Permit/ATC if Different than Above Hailing Address City/State/Zip �M G 3. Application For: Site Evaluation Improvement Permit/ATC G)Z8_[/jl 11 Both 4. system to service: )House ❑ Mobile Home 11 Business ❑ Industry ❑I Other 5. If Residence: # `People e # Bedrooms 2, # Bathrooms 2 ❑ Dishwasher ❑ Garbage Disposal /�, w—hing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type` # People # Sinks # Commodes # Showers # Urinals # Water Coolers F FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: 0 County/City )Well 0 Commmity a. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes )kNo ..l E?S -"-'IMPORTA T***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 3 2 S X -766 DIRECTIONS(tram Mocksville)to PROPERTY: Tax Office PIN:. # D 3 �- � �-' � Z ,00�� 7TE` oG�OP)n 6/ /l�0 �li �o bely i✓re4 Rd Property Address: Road NameOf n » �' Did // / Cih/Zip ry? C k l•le AC22o?v, / I n�erSon 07ACJ If in a Subdivision provide information,as follows: Name: Section: Block: Lot: 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. I,also,understand that I am responsible for all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the D ie County Health Department to enter upon above described property located in Davie County and owned by0 I��Saw to conduct all testing Jprocedures as necessary to determine the site suitability. DATE / 3 / - fie SIGNATURE ` THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAW 1 rip�c tion No. Invoice No. Revised DCHD(07/98) 4✓•-hk 4,3 »� mei�,d,�' gel. :�`r^ rh.�`�,i,✓4,1�M�ti t �� } r�• �`;�Aad#1•My� .f 7ti"�Ti11- �•Ji'�T'� 1 f � �- ..�'t x T. a� ",'� �T 4•' H tf� Y rf � �� # �' ifs •- ��.�e {�}� •. • f'C."'j�i .t r`•-+Ar• � '�•- e" .3. ,r -•�'tl 'S k',�Y, <� �� alt +^ �-� �. ♦"`' M ' , }�. t t'.Lw r �� � �r��+}„� �. � �':= rs r � •. t?'' # #' fig: � "`� - ...'t "c..r� `•` Y .�'y ''t�11"'�`�+1',»" few. • # -1 . -,�, � 4 ,•-1 a;ypt7� y.�A�"4. �`S w+4: -,gyp+," **s 2� � mow*'.' ;ia�: ., , ! , •�;tA2j"e�,��y `��� { '+I.YA�+�f�. ..1,s�j��joi� � fy��,��. Sit.. �,� -. `'_f.. %-' ' �+A' ,•. r'ay'LL. 't� X�� t���` y�;v�f�,k' �. f tC C. -, sr Q r'EtEf'':. ,`i t 'Q4 '"•' '.`� 1i1+wy„'Sr, .`'M ,'Ja7 1 ,. ,�.7tr .�f�i- O .• �y��!•Nst,.3 ,J Z10 f!a F? •iY. 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S� •.,• 'e�s{O' .fit �1T — •a +3<t � �r��7 T ,,.`� �f•r �~ •f' ys�+.t��. . 5.1�h • T ;� _F 7C �i. i. �. . �'q •'t ' •x J� a� �rrfJr' !I:F • DAVIE COUNTY HEALTH DEPARTMENT �- Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAMES DATE EVALUATED PROPOSED FACILITY rh PROPERTY SIZE SUBDIVISION ROAD NAME SDP vrr,�oirts�./ Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position 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 C SITE CLASSIFICATION: EVALUATION BY: 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 ois 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(01-90) sus ■■■■■MESO■■e■■■■■■■eee■■Sm■■■■■■■SS■c■■■■ ■See■■eN■■See■■■■■■■ ■■■NE■ ■■■■c■■■■■■■■■E■■■■■■■■■ceMEN■e■■■■■■■■■e■S■■OEM■■ ■Nm■SEEN m■■■■■c■■■■■ee■c■NEe■Eeson ee■■■■■■■■■■eee■ ■■N■■■■■Some■■c■■SEES■■■■■E■■■■■e■■eeeSENSE■■■■■e■■■c■■■■■e■■■■e■■MEN■■■eMEN ENE■S■■■■ ■■■■■■■■■E■■■■c■SEEN S■SENSE■■■■S■■■■■■BONN■■■■N■■■NE■■■N■■■■E■■SemMEN■■■mEms ■■■■■See■ ■■■■■■■mE■■■NNE■■mc■■■eee■■■e■■■■■e■■■■■■■■■NOME■NOME■NOME e■c■■■■■■e■■■NcONE ■■■se■o■■ ■e■eSENSES m■■■ceEms me■■■ca■c■■eee■■■■■ee■c■■■■■■■■■■■■■■NEe■■■E■■■■mc■cc■■■■et■■■■■■■ ■■■■■■■■eee■■■■E■■■o■■■■sE■■■Es■c■mcc■■e■E■■■■E■■■mE■■■mime■■mE■■mese■■■■■■so■■■■■■mE■ ■■■mcesc■■■mem■■■c■■■■c■■■■■■■■■■■■■■■■■■�mE■■■■■■E■■■e■■ceec■■so■■■meecec■■mess■■■■ ■■so■■■■■■e■■■■cco■c■c■■e■■s■■coo■■m■■■c■ ■■■■■■c■■■■■■■cc■cs■■ee■■ceocc■■■■■e■■■■■■ ■■■■■■■■e■SEE■■■eeN■■■■■e■■■■■■■■■■■■■c■■E■■■■e■■c■ee■■■m■mmEe■■c■■e■■eemeee■■e■c■■■■ ■■E■■■■■■■■E■■■■Nem■■e■■■■e■■■■■■mS■■■■■■■■■■■■■■■■■■eN■■■NNE■■■Ne■em■eee■■■■■c■e■■■■ ■■■■■■■■■■■■■■N■■■■E■■■■■■■■■■NE■■■scMINE■■■mm■■■■■s■■See■■mem■■■■m■■■■■■emm■■■■■s■ ■c■■■■■■EE■■e■e■■■NNE■■■■■e■■cec■■■s■e■■■eecN■ece■emcs■m■■■■■ee■■■■NEE■■■meceee■■■me■ ■■■msNOSES■E■■■■eee■■NEE■■■■■■■■■■■■■■■■■■■■c■■■m■■■■■■■■s■e■■■■N■■N■■E■E■Ee■■■e■■■■■ ■■■■■■■■■■■■■■E■■■ccs■■m■cc■■■ccem■■■■■m■ce■■msec■e■m■■■Oce■■Nerve■■e■e■■ee■Nss■s■■me■ I!! 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Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phone #�....1.. 336)751'8.......7....6 _ - . .. August 18, 1998 Joey M.Cline 854 Bear Creek Church Road Mocksville.NC 27028 Re: Site Evaluation Tax Office PIN: #5803-31-6892 Ben Anderson Road Dear Client(s): As requested,a representative from this office visited the aforementioned site on August 18. 1998. Based upon the information provided on the application for site evaluation and after an evaluation was completed on the site,the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an improvement permit/authorization to construct can be issued the appropriate application must be filled out and the houselmobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, ee R-- Robert B.Hall,Jr.,R.S. Environmental Health Specialist RH/wd Enclosures)