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229 Meadow Glen Ln � r .• DAVIE COUNTY HEALTH DEPARTMENT �� +(� r ( 7- � / Environmentai Heaith Section �� P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990000782 Tax PIN/EH#: 5812-03-4083 Billed To: Brian Lusk Subdivision Info: Bellhaven Lot#3 Reference Name: Location/Address: Meadow Glen Lane-27028 Proposed Facility Residence Property Size: 12.617 acres ATC Number: 3865 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST BE ISSLJED by the Davie County Environmental " Health Section prior to issuance of any building permit(s). T'his 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 CONS R TIO S VA OR A PERIOD OF F VE YEARS. Environmental Health Specialist's Signature: Date: f� - CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemendOperation Permit t Y 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 L� given period of time. Y�� I-{oJ�� a � � a � n,a� q A , �lG� �F ST� C-'""-►+.,R3't I ��1��4n�-� Septic System Installed By: L=� V Environmental Health Specialist's Signature: ate: � DCHD OS/99(Revised) - � - . � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • � P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (33G)75]-87C0 IMPROVEMENT/OPERATION PERMIT Account #: 990000782 Tax PIN/EH#: 5812-03-4083 Billed To: Brian Lusk Subdivision Info: Belihaven Lot#3 Reference Name: Location/Address: Mea�Glen Lane-27028 Proposed Facility Residence Property Size: 12.617 acres ATC Number: 3865 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction ofa septic tank system or any wastewater system. An ALTTHORIZATION 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 ' �5�. #People #Bedrooms � #Baths � Dishwasher: � Garbage Disposal: � Washing Machine: � Basement w/Plumbing: ❑ BasementJNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ��.�i� Type Water Supply l,Ot,��a'Ttij Design Wastewater Flow(GPD) ��� Site: New u Repair❑ System Specifications: Tank Size Ia'�GAL. Pump Tank GAL. Trench Width�" Rock Depth �Z-�� Linear Ft. ��� o�h�: � ��5�����t�,� �cS ��_,,_� � , Required Site Modifications/Conditions: I[JSTA Gc7��2 F+=U" � L171�}�.I �. , � �� I1�1PROVEl1'IENT/OPERATION PERMIT LAYOUT- APPRO EFFLUENT FILTER. RISER(S) IF G"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe 'e County alth Department for final inspection ofthis system between 8:30 a.m.to 930 a.m.or 1:00�,m.to 1:30 p.m. the da f in ati . Telephone#is(33C)751-8760.**** � ;,;,+'+e,� L,FS . ,, � � �;c� .,��"�y �F,�a� L�..�,-5 ►� �� . �50� �� _ � ��!��t����� S � � �s2� ���-w.� —8' �`?.�i c:�h�-'�� Nd..�j e �Ir� � 3� �7��1� P��s�,� P�-�-1 T— � �$� Nc� �3'P.���,-S P��-R--1S�c,�, 1 �� ��1 Environmental Health Specialist's Signature: Date: "/ ' ���"�/- DCHD OS/99(Revised) � . � DAVIE COUNTY H�ALTH DEPARTMENT ` Environmental Health Section ' � � P.O.Boa 848/210 Hospital Street ��C/�-J 7 v�-� . Mocksville,NC 27028 (336)7S]-87C►0 IMPROVEMENT/OPERATION PERMIT Account #: 990000782 Tax PIN/EH#: 5812-03-4083 Billed To: Brian Lusk Subdivision Info: Bellhaven Lot#3 Reference Name: Location/Address: Meadow Glen Lane-27028 Proposed Facility Residence Property Size: 12.617 acres ATC Number: 3865 **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 Y #Baths � Dishwasher: � Garbage Disposal: � Washing Machine: � Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �Z��0 �' � Type Water Supply �`�u"�1 Design Wastewater Flow(GPD)�� Site: New� Repair❑ � i 1 J i� I System Specifications: Tank Size ��GAL. Pump Tank GAL. Trench Width � Rock Depth /� Linear Ft.Je� other: '��/�157�I�t�c�'�� � � Required Site Modifications/Conditions: * �i� � ��6�� �� ,�1 � -' �r�M-' � IMPROVE111ENT/OPERATION PERh'IIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Deparhnent for final inspection ofthis system between 8:30 a.m.to 930 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. T lephone#is(33O751-87(0.**** � �D \ �' J ��.�'�� f l , Q��� � L G . ` `Ay � ��`M�`�, � �� � �� y � 1 � � _ �-�-��= ���, i �a � �� , ��r . _ A#�c.3��,� n �o L� �► J j p Environmental Health Specialist's Sign e. `"" '*� Date: DCHD OS/99(Revised) . • �, �....�...�+�+�""""... �� ;,� � (� �, U � I ION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC '4, �,i�� Davie County Health Department "` � `' r� Environmenta/Hea/th Section . ��,,� � A�� i�.l�� �~'`'� P.O. Box 848/210 Hospital Street '.�a • Mocksville, NC 27028 ; ������ � (336)751-8760 �.-�'�" , *** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TFiE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to ba Billed � (1������/ �y16� Contact Person Mailing Addresa T��i' c��_�- ����� Home Phone 13��� %�'! z '– 5 U�Z'1� City/State/ZIP �7�'�,�/�.;<_i �c:�� � �j�G, zc`��usinass Phone �`]4y� — G�G r�i�� ���s�� 2. Name on Permit/ATC if Different than Above Mailing Addreas City/State/Zip 3. Application For: ite valuation !XJ Improvement Permit/ATC ❑ Both 4. System to service: HL�i' ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type syatem requeated: Colf� nventional ❑ conventional modified ❑ inn vative �! ] �, � '1��� � 1� �i/Z� 6. =f Residence: # People # Bedrooms _� # Bathrooms � L�bishwasher L7Garbage Diaposal asL+-t9P�hing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. I£ IIuainess/Industry /Othar: verify type # People # Sinka # Commodes �_ # Showers � # Urinala # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gailons per aay) 8. Type of water supply: �County/City ❑ Well ❑ Community 9. no you anticipate additiona or expansions of the facility this system is intended to serve? �Yes ❑No If ycs,�vhat typc? ***IMPORTANT'�** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION R�QUEST�D ' BELO1i�. Eitl�cr a PLAT or SIT�PLAN MUST BE SUB�IITTL•D by the clicnt witl�THIS APPLICATION. Property Dimensions: l 2- �l/ �� WRITE DIRECTIONS(from Mocksvillc)to PROPERTI': Tax OfGce PIN: #��r�- 6�— `f CJ_'c � (.P O � /� � c� n L(,g �-� ' Property Address: Road Name �1e�a� C�-e^� L"`"� -� ,//" 1 e e�c9� � �--e"-� _ City/Zip 2�a ^�-b� L2�� o �� • v � �� � If in a Subdivision providc information,as follows: � fi� Namc: Section: Blocic Lot: 3 Date liome corncrs llagged: ��� d 7 This is to certify that the information provided is correct to the best of my knowledga I understand that any permit(s) issued liereafter are subject to suspension or revocation,if thc site plans or intended use cliange,or if the information submitted in this application is falsiCed or clianged. I,also,u►rderstaad tlrat I anr respo�rsible jor a11 charges i�rcrrrred from t/iis npplication. I,licreby,give consent to the Autliorized Represent:►tive of tlic Davie County Healtli Department to enter upon above descriUed property located in Davie County and owned by to conduct all tcstin proccdures as ncccssary to detcrminc tl�c sitc suitaUility. , DATE � 3d U SIGNATURE `�- / ` THIS AREA MAY B�USED FOR DRAWING YOUR SITE PLAN(Include all of tl�c following: Exi ing and proposcd property lines and dimensions, structures, setUacks, and septic locations). Sitc Revisit Chargc �c��/ ��. -�—� 5 t�-e-' vatc(s): � � ��L� �� /u c �- Clicnt NotiCcation Datc: ' � V� . [ ..� � � � 5 ✓_ �HS: � � ; �� �i Sign given �� E yH. � ,. Account No. �U � �� Revised DCI (OS/03 � Invoice No. L�3 � � ``�,�,�� 1500N / � I 41]9 / (282A) I � / ��' �_, 238 - � , �,:. 228 � 2P3� _____ � aa 235 •-- __ �iJA ,a�A s � , ,.,,,__ " f , , anu _ / ""' O r ""'- � O � "_""'_'_" , o, ' � �„ w G LE .s .�a SB� • (22 OBA) 10ifiF 5051 t3t2 i �� {C . , 8 Z�g���� r „58aA� 12fitA � .: ."__"_______".__"_, 61>2 aC83 - . � ' _ V �. . �{ -C] �_- , � � v� �zaa sw , �w +os I icx sse � , ' DAVIE COUNTY HEALTH DEPARTMENT ' Environmentai Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000782 Tax PIN/EH#: 5812-03-4083 Billed To: Carl Lusk ' Subdivision Info: Reference Name: Location/Address: Meadow Glen Lane-27028 Proposed Facility: Residence Property Size: 12.617 acres Date Evaluated: � �'� �-� Water Supply: On-Site Well Community Public ✓ Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition L � Slo e% Lfl HORIZON I DEPTH �-(p �- l.i �- Texture rou : t�- ; lr Consistence ti rJ Structure C-s.R Mineralo �-�*b. HORIZON II DEPTH Q- �' � Texture rou Si�-- . C-- �C- Consistence `S� - ; � Structure ' Mineralo , ,, HORIZON III DEPTH � Texture rou 5�Cf 'Ur Consistence, � Structure � Mineralo � - HORIZON IV DEPTH � + Texture rou S� 5� Consistence r�� Structure Mineralo SOIL WETNESS � RESTRTCTIVE HORIZON SAPROY,ITE '`. S CLASSIFICATION LONG-TERM ACCEPTANCE RATE L`�. � �j. , SITE CLASSIFICATION: EVALUATION BY: � ������ LONG-TERM ACCEPTANCE RATE: ' �� OTHER(S)PRESENT: REMARKS: � '^""Var ���� ,2 ' 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 Mineraloev 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 OS/99(Revised) ■�������■��■■�■�������■��■��■�■���■������■����������■��■\����■���■ ■■���������■■�■�■�����■�������■�������■���■���0��■■����■������■��■ ■■����■��������������■■■����■�■���■��■���������������■�������■■�■ ■�����������/������������������■ ■������������������������/�/���■ ■�\��������■������■���■��■■■����������■����������������■���������■ ■�����������■����■�■■����■�■��■�����\������������������■���������■ ■����■���������■�����\����■��■�■���■��������������■■���■�����■�■�■ ■���������■���■�■���/■■��■■��■����■�■■■������������■���■�������■\■ ■■����������■�■��■�■��■��■��■�■��������■��■����■������■����■�����■ ■���■■���■■�■■■��■�������■����■��■■��������■��■■�■■■�����■��■����■ 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■■■■���������■■■���■���■���■�■■■�■�■�■����■��������■�■■������■���■ ■■■�����\��■������■��■���■■■���■ ■■���■��■■�������■�■�������■���■ ■��■���■��■�/��■�■�����■�■����!!■������■��■��\�■�������■■�■��■����■ ■�����■■■��������■■■��■��■■■��\�����■�����■����■■�■�����■������■��■ ��V ,�� � . ��d , ,, , APPIJCATION FOR SITE EVAUTA�IION/IMPROVEMEM P�iMIT&ATC �,a�r��M t2 � ' Davie County Health Department D � l� l5 � u 15 � •. � �• - Envjrtinmenta/Hea/[fi Se�ion �� P.O. Box 84B/210 Hospital stseet SE� 2 � �� U��C� �so�s��ie, Nc 2�oze (336)751-8760 1U ENVIRO�R;tENTAIHEALTH � ***Il�ORTANT*** THI3 APPLICATION CANNOT BE PROCESSED LTNLE33 ALL QUIRED � ��YFORMATi�N Is PROVIDED. Refer to the INFORMATION BOLLETIN for instructiotts. ,, 1. Name to be siiled �. �2G S Gontact Beraon Mailinq Addre�a G,3 Nq ,c�,e �,b 8a�e IIhone 9�/G � S GG Z Clty/StaYe/ZIP i�ruSvic�� lllC 7'7o ZS Buainesa phone�7o y) - G3( - �G� �rr yii,3 2. Hame on Bemrit/ATC if Different thasi Above Mailing Addreas City/State/21p 3. �lpplication For: [Q�ite Evaluation 0 Improvement Peanit/ATC � Soth �. Bystem to Service: �use ❑ Mobile Home 0 Business 0 Industry ❑ Other a. If itesideace: # People �,� ; Bedrooms � f Bathzooms Z 8'�Diahwasher @��arbaqe Diapoaai �ashinq tlachine O Haae�ent/Piumbinq O Basement/No Plum6ing 6. If Buainess/Induatry/Other: Specify typa # Beapie � Sinl�a ♦ Coamodes / 8howers � vrinala • Nater Coolers �s' FOOD3ERVICE: � 3ests EstimBted Watez Osage (gailona per day) 7. Tppe of vrater supplp: C'�ounty/City CI tdell ❑ Com�unity e. Do you anticlpate addition�or e:pansions of the facility t6is ayatem Ia intended to aervei ❑Yes 0 No It yea,�v6at type' *"IMPORTANT't"'CLIENTS�llUST COlilPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PL.AT or S1TE PLAN AtUST BESUB�tITIED 6y the client wlt6 TH1S APPI,ICATION. Property Dfinensiona: l����7 /���'�S WRiTE DIRECTIONS(from Mocl�ville)to PROPERTY: Ta:Office PIN: # �g / Zd G/�//d� G� 1 1�1a2T►.� �o �//.�r�.zT; �v�c,y Prnperty Addresa: Road Name///�rlooc� ��n,�r �r�„i� 12.o f,��T' v,d,P G�>6�.c�: �'s>virc.�/ City/Zip ii'"/oC�rsvit[tt3 Z7GZv �� �,����zs�s���v ��� ��n�� If in a Subdivi�ion provide fatormation,a�followa: L��i O�'% O� L� /L� Name: �GT. � Section: Block: Lot: 3 Date Property I�lagged: �� �G�.�� This is to certify ihat the ioformatioo provided is cornect to the best ot my knowledge. I underatand t6at any permit(s) issued 6ereafter are subject to su�peosion or rcvocation,lf t6e aite plan�or intended usc cbange,or if the information aubmitted in t6i�application ia falsitied or chaaged I,a[so,unders�tand tbat I am responsiblejor a/1 cha�ges incurred from this applirasion. I,6ereby,give conaent to the Authorized Representative of the Davie County Health Department to enter upon above descrfbed property located in Davle County and owned b�- f/-�v�en?.n �YI,_ _�S,-r�p�✓�cs to cooduct all teating procedurea as neceasary to determine the s�te auitabili �. �� .� DATE �R� _ SIGNATURE . TflIS AREA MA.Y BE USED FOR DRAWINC YOUR SITE PLAN(Include all of t6e following: EL�ting and proposed property liues wud dimeasions, atructures, setbacks, and aeptic locatfons). Account No. I �� Revised DCHD(07/98) invoice No. �'� � . S�ephen S :mr � . . . . � '^ D.B. 175 -�715 ^ � � S , m 5 � °�\ 1w �, �,. PO�CtI Z� I H \ J� 9sE. Lowell Rewie o Mo ey y�6 o.B eb - 355 . 15.002 ACRES �Or.b as o �9. Z ��M1 o , � S Sj� OP �� �B"9o•. F � S ��'� ps 5. 9ssJ f �zqs ': � 62J.ta• E 6J. y ��z . �jj baR^H../ rm ' H �.,:>��,': .__ .(�o�:on.) __ .. - . .— __ _ \ // . _' /6 y. n' .0 O�ry V / �o ////\\// \\\\\\�� ' " 6 �./ P O ° �� �� ,� , � • '� s s so.00 .�.� , b .M1 �� � zr>���� y ^¢ ^;1 yp0 rJe.,lp. y ' �462 ACRES ti„ � �� " � i W O N m //�� � N Y � V v! � N ' N 3 I �.el 25 �,6 0 � z ^ ,`' I � :. B.a�ke� � O m I. 41 - 447 /�O .� O !� o � : ^ , p� �6 ( y � o m �5ti ,5� 3 h ,. z m o � o „ 12.617 ACRES � 11 .032 ACRES �, a 0 � � " � ' t078.80' 285.46' 3t4J3' �O"��eV N87•73'20"W t364.26' " �> � N 86'30'10'W i I I r � I ParcN 20 I Parcd 20 John C. Hvnee John C. H D.B. 42 - 340 D.B. t00 I I Ii.c�n ow..sri uw w.r�a.�I'^w'^ (aw w.eW+ I .y.,w��.....ws..��r.�.'...a.�^r�w.i+.� �...+d w s.+�xw w���(rA.�M.�..m+ra.w w m e.��.a •��^M u.nn.r rd+^s d°'Mw��:�awx uw vr V�T�J M G3.�)-JO e s�WG �Ib�^'J sY'd I ����� �� �x 1806 xr�M a en. ,a`� . O . 5vai or Slomp _,� �f�— �2�P ' �iT a a.+.� 262} - '� �,pN,.aa..w� ' ;=`S ( by d.m.d. ) • ; - ' , • ^ DAVIE COUNTY HEALTH DEPARTMENT v y Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000782 Tax PIN/EH#: 5812-04�909 Billed To: Carl Lusk Subdivision Info: Reference Name: Carl Lusk Location/Address: Meadow Glen Lane-27028 Proposed Facility: Residence Property Size: 12.617 Acres Date Evaluated: �a–���� 7— Water Supply: On-Site Well Community Public Evaluation By: Auger Boring v Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition Slo e% L HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH ,� " � G v Texture rou G Consistence i Swcture /� i �/ Mineralo , - HORIZON III DEPTH Texture rou Consistence Structure Mineralo � HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON . SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE � i 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-Tenace 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 MineraloEv 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 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, � � � .. � - � Btk�fI� E�UNTY��LT�I I���'ik�T��t`T ENVIRONMENTAL HEALTH SECTION P. O. Box 848/210 Hospital Street Courier #09-40-OG Mocksville, NC 27028 Phone #: (336)751-8760 � October 7, 1999 Mr. Carl B. Lusk 1031 Cornatzer Road Mocksville,NC 27028 Re: Site Evaluation/Meadow Glen Lane Tax Office PIN: #5812-04-4109 Dear Mr. Lusk: As requested, a representative from this office visited the aforementioned site on October 6, 1999. 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 house/mobile home location stalced of� If you have any questions, please feel free to contact this of�ice. Sincerely, �,��t����• Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/mp Enclosure(s) , , � '22•o3e '63•3s• , �'�T'=r � , � � � 4' ' \ i ' . _ ' ' �` � •32' ' q . . . . .• � � . , � � . . � � � n (�, i . �o r s . t� y o !�•'Y���� '. . iN YJ �s. � o a,p � k ti F �� � � 0 15 . 0 0 2 AC RE S, s��o����8 z ' �� s9- � ,�� � . � � . � c���e ��1U`� . Qj �.v-� �K � s �� s'°o� �„ ,�,��� � { . ^ 779 Ap.� , � '.. � , b -��..� . ., . . . �,' S��, '�4 ' . � o Y� � ' • f ' t 66�' �'� .... � . . . 3 V� = - - --(�tona�pile)` ... . . 1 . . . . �.� _ . � \ _ �--���--- � o N N,t � � ; �`_ w o` �Jtero / , ^` J � � ',.�'N ��, � �' �'';;::v�'. � , � , � � • . - d• . r '� � �.:....,�, k O ti r ��\ ���� ����� `5 �-�.er,-..: �._ \ ' " . 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