396 Ralph Ratledge Rd "'Y . �:f:. � :� r.f�t Vai - �1 . d , � � .,.- ....�., :. .
�..� • \i. . t � f ���'—t�� ���+�•.
: ` Permitt 's--- ' 1 �.�' ;R•.DAVIE COUNTY HEALTH DEPARTMENT `
'-�' Name:� "'�-=��'�' - Env�ronmental Health Section' , PROPERTY INFORMATION �
' , ......; .�. P.O. Box 848' � ff�
��=Direc6ons to property:, �.-�'"�-'/ � �� Mocksville.NC 27028 Subdivision Name: / 3 " �;�'`�d�
>�' G;,�r� � �j'? ,1 W.� �,,3 �,� Phone#: 336-751-8760
- Section: Lot:
(' � (�� , AUT ORIZATION FOR
� ��'%�� �TI�� '�,�`G?� .K'�(,,.F'�t� ` i ��ASTEWATER
SYSTF,M CONSTRUCTION Tax Office PIN:# '
� `� ��. _ �.. �"'�, �"�i ���' i�-�=�r`'�
AUTHORIZATION NO: A. :: Road Nam''�'�� `""''�� � �ip:—"��� '
. ,
**NOT'E**This Authorization for Wastewater Sysfem Construction MUST BE ISSUED by the Davie Counry Environmental Health Section prior
to issuance of any Building Pernuts.This Form/Authoriiation Number should be presented to the Davie Counry Building Inspections
Office when applying for Building Permits.
(ln compliance with Article 11 pf G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
�t_.--a r , ,
� fl` � � ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION '
I i' � (�� �� �� - IS VALm FOR A PERIOD OF FIVE YEARS.
ENVIF� �IQ� N A�IrTH SPE ALIST DAT ISSUED
,, , ,, ,
. , , _•... . :. .. .:
RESIDENTIAL SPECIFICATION:BUILDING TYPE 1'��+ #BEDROOMS�#BATHS � #OCCUPANTS �"" GARBAGE DISPOSAL:Yes or No
, , : _ . .., �
COMMERCIAL SPECIFICATION: FACILITY 1'YPE #PEOPLE #PEOPLFlSHIFC #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE��—` �� PE WATER SUPPLY ��'""�"�DESIGN WASTEWATER FLOW(GPD)�:NEW SITE REPAIR SITE V
SYSTEM SPECIFICATIONS: TANK SIZE�"" " GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: � � � t��V� �7���`++'`�� ' �.' " r''-" F�-��-
'�l�`""
IMPROVEMENT PERMIT LAYOUT
V
�
��T -��,����
t / �
� � s 1` �t
1�-EavS� �C�7 ,
, �� .
•*CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-930 A.M.OR 1:00-l30 P.M.ON THE DAY OF INSTALLATION:TELEPHONE#IS (336)751-8760.
OPERATION PERMIT : /�' p�,Q, �/�f�
• SYSTEM INSTALLED BY: �=�/"�1--S L S C�`'T7t/
� �S St��a
. Ti�Nk �5 .b5'oF� �et9s�
- t�-6�x �s ���n-�- T�,�
' � �A-a� �= S''��
AUTHORIZATION NO.�OPERATION PERMIT BY: DATE: -/ �`� �/�
''*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE S DESCRIBED A HAS BEEN INSTALLED IN COMPLIANCE
- WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECI'ION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCfION SATISFAGTORILY FOR ANY GIVEN PERIOD OF TIME.
DC:HD O?102(Revised) . . ... •
. �
� . - DAVIE_COUNTY'ENVIRONMENTAL HEALTH SECTION
� APPUCATION FOR IMPROVEMENT PERMIT(REPAIR)
<� � � �j� �
NAME " -�� �� PHONE NUMBER �t"I� Z��� �
n,� � �
` ADDRESS ��,Cl� �'�T��� t�/ SUBDIVISION NAME �
LOT # ' U
DIRECTIONS TO SITE �
� � �
. c
�� ��-- �b
DATE SYSTEM INSTALLED �� NAME SYSTEM INSTALLED UNDER
TYPE FACILITY ���� NUMBER BEDROOMS � y NUMBER PEOPLE SERVED ��
TYPE WATER SUPPLY �N t� SPECIFY PROBLEM OCCURRING ������j�� � S�
T
A
M
DATE REQUESTED � � 1 INFORMATION TAKEN BY a
� �
This is to artity that the iniormation provided is correct to the best of my knowledge,and that I under tand I r sponsible f I charges incuned from thia application. �.
;SIGNATURE OF OWNER OR AUTHORIZED AGE� �' ���0,
Rev.1/93 ,
,.ycy`'D-rw.�i+�t,oHi?'i�:Yirii�.�„�.s:r,l,y�rsc..�'���+�:'rk���'""'§"�11'im'F'�.��'7.C".S'�t r^r.t3w�f''w�itr,y;:�Y^r y •.ry., s �; .,_. r .....-•. - v+`�.. .u�r��..i:.�l.�•��;,y. .
_ . �;` �?j� �-����4�� �;}
y . . �-
AUTHORIZATION NO: /� � �j� ',DAVIE UNTY HEALTH DEPARTMENT- p
` '- ' � ` �Environmental Health Section PROPERTY INFORMATION
Permtttee's �aµ �j ' � P.O.Box 848; ..
� Name �'• I�Bi�� Mocksville,'NG27028 Subdivision Name:
Directions to ro ert I t�� C3�vJ�'Tu � Phone# 336-751-8760 •
,. P P Y:�- Section: ' . Lot:
:. - AUTHOWZATION FOR � /��I�
� �i�lr�E i�,L'� � � T�[�2n� � C�� , WASTEWATER' Tax Office PIN:# �$�� _ ' 3t'�� - 7 /�
,i �;
�l ' SYSTF.M CONSTRUCTION —
�f�L'f�i 1 ���7t.r�',���c �O� 1 ���T 'q y3G� or.� Lif-j Road,Name: ���R ip; ����
**NOTE**This Autharization for Wastewate�System Consuvction MUST BE ISSCIED by the Davie County Environmental Health Section prior
ta issuance of any BuildingPemtits.This Form/Authorization Number should be presented to the Davie County Building Inspections �
` Office when applying for Building Permits.. .: • � ' ' .
(ln compliance witti Article�1 of G.S.Chapter 1�OA,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems).
..__ ,
. ,
i ��� " �,� ;.--- •**NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
� � � ° 'IS VALID FOR A PERIOD OF F7YE YEARS. .`.
�. ENV(�20 ENTA HEALTH CIALIST , ATE ISSUED;., -
� , �
�'T� n:.�'t,� "'r"f"f t+..,-c� `Y y ^'r� .a r r ir J '¢ y . �� _,,a. . ..... ... ^..✓�.,...V, i!i
�rt ..d �h11Y '.r,'� � �+v"� k •3� �+ i r�a,' y, .. ' 1�� ry�fqy�,Nti..
.��
., , _.. Y,�`� _ t �' p�xv
- : _ . . : �
; . _
�� f � . . . , �
� f .•�: �: �.:, � ��"� ��DAVIE (�UNTY HEALTH DEPARTMENT`
. �„�-¢.���_ '. ��. � . 11V1PR0 E1�IENT AND OPERATIONPERMITS PROPERTY INFORMATION
Pe�nit�e�.'�s ' ,°� �. ,, � ' ; . '
Name ' ����''��, '�D l�`�� Subdivision Name:
, .
s . . .; : � , , . ' �
�Directionstoproperty:`� �1•'�( 1 i) t�} -1�� � ,. Section: Lot: '" .:
t,�",' . `� � IlVIPROVEMENT • . '
l �E 1�:.�'� ��� � �.,^.. F jG!�:rJ '�. , �^;,;;;j PERMTT . Tax Office PIN:#���� _ .3d ���, �
l �.o t:1+i t •1 f<i:r. .. t"k"; 1'�i��� � '��ti�Z '"� L.�:•� � Road Name;,���.itl�i`��-Zip�x`r0;�
**NOTE**This Improvement Perinit DOFS NOT authoriie the construction or installation�f a sepdc tanlc system or�any wastewater system.An:
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained frc�m this Departmerit prior to the
, �� :, construction/'u�stallation of a system or the issuance of a building pernut. •
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section:1900 Sewage Treatment and Disposal Systems) �'`
_ /
� �` `�`".x� � ,�-.� **#NOTICE***THIS PERMIT IS SUBJECT.TO REVOCATION IF STTE; .
�,,,1� �r �I r ;_ . . � 1 PLAN5 OR THE INTENDED USE CHANGE.'YOUR WASTEWATER .
„r-�- �, . ...� �j .;' „�-�j ,
`� ,:. SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE :
•�_ ENVIRONI�3ENTA'�.HEALTH SpECIALIST DATE ISSUED ; '
� � ; �..
INSTALLING THE SYSTEM.
. . , �/�„4t.� , `� : ' . � ;; . _; . �: ::._ : � ,
RESIDEN7'IAL�SPECIF7CATION:BUILDING TYPE , U V��BEDROOMS i� , #BATHS L #OCCUPANTS .�- GARBAGE DISPOSAL:Yes o�
' �� COMMERCIAL SPECIFICATION:FACILTTY TYPE #PEOPLE #PEOPLFJSHIFT #SEATS INDUSTRIAL WASTE:Yes or No
� LOT SIZE���`-'��E ATER SUPPLY��-L DESIGN WASTEWATER FLOW(GPD)�_ NEW SITE �REPAIR SITE
LL ;
� SYSTEM SPECIFlCATIONS: TANK SIZE�QGAL. PUMP TANK GAL. TRENCH WIDTH �p', ROCK DEPTH�_ LINEAR F1'., 3��'
o�. ., . . : ;_ . yj�
o��x �OC�O C�� • Sc.f>s', �Ta.J��, � �i �ST��f3u1i�.� r�c>u.c,.� , 4PPQvJc� �Tc.r.'r {'�
� ' ~ - F��t�.a
� REQUIREDSITEMODIFICATIONS/CONDITIONS:�tJSTALI.. b^� ' L.OnI"TDv2 ,�LL.�� SD F�C�nti ln��=�-1-� K�,�P •Z/JI-7
" � �a'-_F�iC..-tar�lt 15�ca�f- ' � � E��'� SUQFn[.` w/-11�2 i��Vi:2S�o�1
�.
� IMPROVEMENT PERMTT LAYOUT �
iuo' -� F a�;r��. � "f`a,a KCs� M USr ' u�v�.
� ,
(�i5�� �.�s�t-n�.�.�:� ��
�a�s�'�� . C��.aZLrz�un�J �'BC� �
� �I �f��x: c�rz.�c�� �
'�F��� ��U so��� . � :
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1��' . �c;e A.. �,��2
2� �f�'"�` ,
� `�-�7,�r��,� N� �.'+1}°
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��5.� �r'-o�T �5�. ..�' ��
� ,� '.
�
/ �`�;.''"a''� #^a/K � . . �' :
. . � ' - . l�� .. 1� . . . i'„�SSJ.
"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM .
BETWEEN 8:30-930 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760.
OPERATION PERMTT /�
���SYSTEM INSTALLED BY: C�,.
��:�i en•- P-.�•���� �� N�.�,� .
M, -T-���c-�.A--� ��-��
�--r.�u��n �� r..�S .
�23�
� �� ��,� � A���� T
T
� ���
�'`' �� �� �oZ'� ''�i2� ,
. �.rL.....:�T �s,u,,: ,E • �,� j� � ::
� �.Qur '� F�- �'�� , ,
� �-,e,;sk. ` �,s�-r►�-�. ��� ' i°`�
, 1 ��
, �P-Fl� '3�' �°"''
5`�jr�r•_.. ' `Sti ',
1 ` ;� r ' ` :+R1(},r ^� '�= J'�
� AUTHORIZATION N0. ,�����PERATION PERMIT BY ' �T' � - + DATE: -S
_. �, �
�`�,._..,_,..� t
*•TE�ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT STEM DESCRIB BOVE HAS BEEN INSTALLED IN COMPLIANCE
W1TH ARTICLE 11 OF G.S:CHAPTER 130A,SECfION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A
. GUARANTEE THAT TI�SYSTEM WII.L FUNCTION SATISFACTORII.Y FOR ANY GIVEN PERIOD OF TIlvIE,
DCHD OS/96(Revised) : �
� ,
� _, , ,
APPl1CAl10N FOfl SIIE EVAWATION/IMPROVEMENT PEflMIT&ATC
� � � Davie County Health Oepartment D � � � � d �
• � i��V �`' - Envfi»nmenb/Hea/tfi Se�ctfon
. . �v^P � P.O. Box 8�B/210 Hospital street
,. DEC —9 i998
cJ ��('�` Mocksville, Nc 27029
�336)751-8760
• ENVIRONMEMAL HEALTH
*t#Il�ORTANT*** THI3 APPI,ICATION CANNOT BE PROCL�SSED TJNLE33 ALL THE
INFORMATION I3 P120VZDED. Refer to the INE'OR�TION BOLLETIN for instructions.
�. p� ,� � s���� �ti►� S. l�nc�S� ��at �� �l� „� S. ��.��_
��ing �es. _�a i J�-��� �2� � ��� �9�r � 2S �4
�t7//State/ZIp _�yIOCKSUI//G /V� Z 7v Z y Businesa Phone
—�
2. tiama on Pe=m1.t/ATC i! Difterent thaa Abov�e
1lailinq Addresa City/Btate/Zip
3. Application Sor: U 3ite Evalnatiott 0"Improv�ement Permit/ATC 0 Both
�. syatem to servtce: �Honse �Mobile Home 0 Buainess U Industry 0 Other
s. If Reaidence: # People � # Hedrooms � # Bathrooms _�
�ishxant�er 0 Oasbaqe Diaposai O�Sshing Machine 0 Haae�ent/plumbinq 0 Saaement/No Plumbinq
6. if Bnsiaeas/Indnatry/other: SpecifY type � people / Sitil�s
i Cammodea i 8howera f Urinals � itater Caolers
IJ�' FOODSERVICE: � 3eats Estimated i�ater Osaqe �qalloas per day) .
7. Type of �rater s,spply: ❑ conuty/city B'FTell 0 community
s. �o you anticlpate additiona or•e:pansions oi the tacility t6�s ayatem�intended to aerve? 0 Yea [�'V`o
lf yes,what type?
•*"IMPORTANT'*• CLIENTSJIlUSTCO�IlPLETETHE REQUIRF.DPROPERTY INFORMATION REQUESTED
BELOW. Eitber s PLAT or SITE PLAN blUST BESUBbt17TED by the cl(eat wtth TIiLs APPLICATION.
Property Dimenaions: 35, � Z WRiTE DIRECTIONS(fmm Mocksville)to PROPERTY:
Tai Office PIN: #S�// 30 9 7 3 ��0 DDl��� /�p/ � To ��c c ��/e�o�E�' ��
Property Addresa: Road NAme /� /�� c � �!T�f � n�l ��9!a'e,� ���
City/Zip��fc���$i,��lG /YC' 2 7az$ �e�� d� /ru�P'� �a���K�yL �e
I(in a Subdivlsion pruvide information,as followa: �����- �� �� ��
NAme:
Sectfon: Biock: Lot: Date Froperty Flagged: �z���� q8�
This[�to certify that the information pr�ovided is correct to tBe best of my knowledga I underatnnd that any permit(a)
issued her�eafter are subject to su�pension or revceation,If the aite plans or Intended nse c6ange,or N the informatlon
su6mltted in thia application ia talsified or changed I,aLw,understand that I ani�o�blejor o/l chargts lncurred from
this opplication. I,6ere6y,give consent to the Aathorized Repreaentative ot i6e Davie Count�Healt6 Department
to enter upon above described property located in Davie County and owoed b���S�GI/C l�oN�v�{- ,�2����5 �
to conduct all teating procedures as necessary to determine t6e�ite auitabilih.
DATE �Z- �I `GI � SIGNATURE
TH[S AREA MAY BE USED FOR DRAWING YOUR SITC PI.AN clude all of t6e tollowiag: ELsting and proposed
prnperty linea xnd dimeoaiona, at�vctures, eetbxcka, and aeptic loca ons).
'►�' I�o+_ F�'h^ �-� �►,��
��- � -� �
'1,'14 " ��5� � ��°,� �. LY �,��
�� �
Accoent No. ��
Revised DCHD(07/98) Invoice No. ���
r `
, . ti .- APPLICATION FOR SITE EVALUATION/IMPROVEMENT P —
• '� '.� � ' Davie County Health Department ���Q�� ^
.a�_ � p
' '�� V Environmental Health Section
• �(' � . P.O. Box 848 �� N�� � 7,��7
� Mocksville,NC 27028
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed ���''�' �on na Rn�c.Se Contact Person ��1/P_ �!� �J C.Y Y)e ��[�/!X�/
Mailing Address��i n�=t-ra-� Road Home Phone �`7� —oZ5 �� 6-feJ�
City/State/Zip j�� 1/C��, �C �7D��_ Business Phone� —3JJ� ��2.►t� O�T'iC.Pi
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 Serve: �House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other
5. If Residence: #People� #Bedrooms ? #Bathrooms� J�.Dishwasher[ ]Gazbage Disposal
�Washing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing
6. If Business/Other:Specify type #People #Sinks #Commodes
#Showers #Urinals #Water Coolers
If Foodservice:#Seats Estimated Water Usage(gallons per day)
7. Type of water supply: [ ]County/City �Well [ ]Community
8. Do you anticipate additions or expansions of the facility ttus system is intended to serve?[ ]Yes �No .
� If yes,what type?
-�� ' � EZTHER A PLAT OR SZTE P1AN
PROPERTY INFORMATION REQUIRED:***IMPORTANT***��'OF THE PROPERTY MUST BE
SUBMITTED WITH THI5 APPLICATION.
Property Dimensions: �5�g�a�c �SeQ�'f�che� SurJ�ey� �WRITE DIRECTIONS(from Mocksville)TO PROPERTY:
Tax Office PIN: #�gl� _�_ �73�' � �U� (ab� /l� �- / bC��
Property Address: Road�ame`�(��1 �T�P..C�C�p �C+ • � � Ie�t on �2 ��
c�cy�p I^�1oc(c5J� l l�e �70� ; �1�hf ��n x f n h �a 1�d��e �� .
If in Subdivision provide information,as follows: � D 1`I y l�' p, O�C j 2
Name: k/I F� � 1�11��Pi � GL`� �G(5�►1 C� ���c-/
. ,
�
Section• -Lot#� � c���Y1
. ,
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 Davie County Health Department to enter upon above described property located in Davie County and owned
by � � P a to cond ct all test ng pr cedures as necessary to determine the site suitability.
DATE SIGNATUR 1 O
Revised DCHD(06-96)
THIS AREA �I�IJ $E USEb �OR DRttWZNC JOUR SZTE PLAN: �e a.�.�cN�e u copti nf �
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�,'{:r � � Environmental Health Section sECTiort LOT -
� SoiUSite Evaluation
APPLICANT'S NAME �`���I�NQ'�`� DATE EVALUATED Il/1�/�'7 7
PROPOSED FACILITY I`��vs's PROPERTY SIZE �S'�gZ9 ,L1C.2�S
SUBDIVISION � ROAD NAME �t�PN lG47"��
Water Supply: On-Site Well L�Community Public
Evaluation By: Auger Boring ✓' Pit Cut
FACTORS 1 2 3 4 5 6 7
Landsca e osition L•
Slo e% �
HORIZON I DEPTH - fl O-
Texture rou (� G L GL
Consistence ` T .5 5 S
Structure C�
Mineralo /;/ 1:1 ):t
HORIZON II DEPTH -Z - 2Z ..Z
Texture rou C
Consistence i S F:
Structure 5 �. k. �
Mineralo l� : 1
HORIZON III DEPTH � 2� �
Texture rou G f� G� 5� G+'
Consistence i 5 ` 5
Structure , �k A g<<
Mineralo [t /: �:
HORIZON IV DEPTH �{ � �/
Texture rou
Consistence
Structure
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE p, O• D•3
SITE CLASSIFICATION: � EVALUATION BY:,�� '��AUGcIAwQ
��
LONG-TERM ACCEPTANCE RATE: �•3� 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-Angulaz 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-gaUday/ft2
DCHD(01-90)
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� �
,�.� = - � �� � ' � �avie County�-Cealth �epartnient
- � and�Come �leaCth�gency
�nvironmentaC.�CeaCth Section
P.O.Box 848/ 210 Hosrrcn�SraeEr
COURIER N09-4-06
MOCKSVILLE,N.C.27028
PHONE:(704)634-8760
November 19, 199�
Steve & Donna Kouse
221 Dogtrot Rd. ' ,
Mocksville, NC 27028 '
� Re: S3te Evaluation
Ralph Ratledge Road
Tax PIN: �5811-30-9738
Dear Clientts): '
As requested, a representative from this office visited the
aforementioned site on Hovember 18, 1997. Based upon the information
provided on the application for site evaluation and after the evaluation,,�
Kas completed, the site vas found to be provisionally suitable for the
installation of an on-site sewage dispbsal system.
If you have any questions, please feel free to contact this office.
Sincerely
,
!
- Jeff G. Beauchamp, R. .
Environmental Health Specialist
JB/ad ,
Enclosure(s)