170 Brier Creek Road Lot 10Davie Countv. NC
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Friday, December 30, 2016
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Parcel Information
Parcel Number:
H7030A0038
Township:
Shady Grove
NCPIN Number:
5769979459
Municipality:
NC
Account Number:
8305162
Census Tract:
37059-804
Listed Owner 1:
MARTIN CLARENCE E II
Voting Precinct:
WEST SHADY GROVE
Mailing Address 1:
170 BRIER CREEK ROAD
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006
Voluntary Ag. District:
No
Legal Description:
LOT 10 GREEN BRIER ACRES
Fire Response District:
ADVANCE
Assessed Acreage:
1.12
Elementary School Zone:
SHADY GROVE
Deed Date:
6/2015
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
009920985
Soil Types:
EnB
Plat Book:
0004
Flood Zone:
Plat Page:
172
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
Davie County,
All data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
implied warranties of mercharrtability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all Balms or causes of action due to
r'pU
NC
or arising out of the use or Inability to use the GIS data provided by this website.
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION D O`er
APPLII AT ON FOA IMPROVEMENT PPMIT (REPAIR)
NAME lowe da"vo-c- Y(f
PHONE NUMBER
ADDRESS d`a/ 4 r -dr, SUBDIVISION NAM
,0 U 4-1 � %-�, LOT# `o
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED �` ' NAME SYSTEM INSTALLED UNDER--,Jh'54 iihr,h�T
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
IF
TYPE WATER SUPPLY_-4�SPECIFY PROBLEM OCCURRING_
DATE REQUESTED-- INFORMATION TAKEN BY
f r �
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am resp nsible for all charg Q'11 -d from this appli tion.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93 8
Directions to property:
Section: 4 Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION -
Road Name: Zip:
**NOTE** 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)
/s ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
• AUTHORIZATION
NO:
� ,: � DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittee',�,'/�
�
�f,:�
/7 P.O. Box 848 /
Name: ��•�;�`��
�1'ri��
f �ij�
��r 4 Mocksville, NC 27028 Subdivision Name:
Phone # 336-751-8760
Directions to property:
Section: 4 Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION -
Road Name: Zip:
**NOTE** 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)
/s ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
I DAVIE COUNTY HEALTH DEPARTMENT
,^ IMPROVEMENT AND OPERATION PERMITS PRO j,(NFO RMATION
PecmitQ.m.' S
Name:
- Directions to property:
t
IMPROVEMENT
PERMIT
Subdivision Name:
Section:
Lot:
Tax Office PIN:#
Road Name: Zip:
**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
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE l,/ # BEDROOMS ^' # BATHS _ # OCCUPANTS GARBAGE DISPOSAL:I Yes or No
I
COMMERCIAL SPECIFICATION: FACILITY TYPE% # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY ` = DESIGN WASTEWATER FLOW (GPD),,:[6 6 NEW SITE REPAIR SITE
GAL. TRENCH WIDTH ' HLINEAR FT 1/00
'
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK t/77 ROCK ROCK DEPT
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT-EAPPROVED EFFLU-24T FILTER* gRISSR(S) IF 6" BELOW FIMISPIED GRADE*
(1
<d
**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 W 041-i 6.1
(330751-3760
OPERATION PERMIT
SYSTEM INSTALLED BY: n✓r�i% !� // �i�2��tA�i(
w � I
AUTHORIZATION NO. I:ffOPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS 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)
t ..� , i. �} 4.3'.•+r* E: . ! - a'�` ,'S" �;,(��,C 4 � r�v� U' `� � '�l-,..=�,F�^"1' ..'."Sy"'.".e'S^."'"V'.'i... .... �....'y ! 1^'-:� {!.,'�' ^'--'R�ti+'�;
A.' DAVIE COUNTY HEALTH DEPARTMENT - ✓/jJ
IMPROVEMENT AND OPERATION PERMITS PRO O ATION
NATH
Subdivision Name:
'Ditections to property: Section: Lot:
E. r IMPROVEMENT r
t PERMIT Tax Office PIN:# - -
Road Name: Zip:
*.*NOTE** 11us Improvement Permit DOES NOTauthorize the construction or installation of a septic tank system or any wastewater system.1An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
constructionfinstallat on of a system or the issuance of a building: permit.
(b, complianc& with Article 11 ofG.S.•Cbapter 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
._ ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE r
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE /y #BEDROOMS # BATHS _ #OCCUPANTS^ _GARBAGE DISPOSAL: Yes or No
COMMERCIAL.SPECIFICATION: FACILITY TYPE #PEOPLE # PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE ' TYPE'WATER SUPPLY C i( DESIGN WASTEWATER FLOW (GPD) NEW,SITE PAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH _ ROCK DEPTH LINEAR FT./I&O
s. OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT;PERmrr LAYOUT*APPRQVED EFFLL ENT. FILTER* *RISER (S) IF 61"BELOW FINISHED GRADE*
'/
b
'*CONTACT•A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT -FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8 36-- 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS '
1751-8768 ' • .
DCHD 05/96 (Revised)
AUTHORIZ4TION NO. Q 7 8 Q DAVIE COUNTY HEALTH DEPARTMENT
`''FF' ` Environmental Health Section PROPERTY INFORMATION
Perri 4q'e'.'s ,,��%A� ��,.. ` P.O. Box 848
Name- Its Lf a- /.�11%i�� Mocksville, NC 27028 Subdivision Name:
7 Phone #: 704-634-8760
Directions to property: int=��' r' r�gr Section: Lot: ilk
AUTHORIZATION FOR
WASTEWATER J� .�'
SYSTEM CONSTRUCTION Tax Office PIN:#- -
Road Name: r 0)
**NOTE** 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)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
.? DAVIE COUNTY HEALTH DEPARTMENT
�`�''w`"{ .• J IMPROVEMENT AND OPERATION PERMITS
T Peli1'iieeys
Name. x:'"`�{�cwP.°2 X.7 r
Directions to property:
PROPERTY INFORMATION
Subdivision Name.
Section: ,� Lot:
IMPROVEMENT
PERMIT ��
Tax Office PIN:#�
Road �Name:�` : _ f' (�.t k - zip:ci
**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
`. ,� j , ~' n-r,�""°, r") f ; ' ✓� PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE %+ # BEDROOMS — # BATHS 1 # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFP # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY ef4 DESIGN WASTEWATER FLOW (GPD) 'Z-6 NEW SITE t --L REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE , f4 GAL. PUMP TANK GAL. TRENCH WIDTH r/ . ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
�bVj
Ski
**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 (704) 634-8760.
OPERATION PERMIT � y h
SYSTEM INSTALLED BY:0J ` / A✓�C
L
AUTHORIZATION NO. v G oy OPERATION PERMIT BY '43W DATE: �—z0? /
**THE ISSUANCE OF THIS 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)
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PEQ �J
Davie County Health Department
Environmental Health Section MAR 2 51997
P.O. Box 848
Mocksville, NC 27028
M (704) 634-8760
t�
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL v��ry]�
' THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed— �--Ct ✓�14Contact Person 1Uc� �LL✓Yl
Mailing Address 100 -Prc)n—f- iQr— D1 --1V,2 Home Phone
City/State/Zip L f1 C' -f Onl h
� 943 BusinessPhone
d
2. Name on Permit/ATC if Differ nt tha AboveQ�iJY1��9
Mailing Address City/State/Zip
3. Application For: ite Evaluation [improvement Permit & ATC [ 1 Both
4. System to Serve: [Vrflouse [ ] Mobile Home [ ] Business [ J Industry [ ] Other
5. If Residence: # People,3 # Bedrooms # Bathrooms [%, ishwasher [ ] Garbage Disposal
[% Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing
6. If Business/Other: Specify type A L31)4(6V' Se)5.5 # 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 this system is intended to serve? [ ] Yes KNo
If yes, what type?
EITHEIZ A PLAT OR SITE PLAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** &,SOF THE PROPERTY MUST BE
` SUBMITTED WITH TAPPLICATION.
Property Dimensions: �WRITE DIRECTIONS (from rocksville) TO PROPERTY:
Tax Office PIN: # � h - q 17 - 1 HW ` Ow,c,"re l LOX ��,`l ^✓1
Property Address: Road Name %01'�et'�� �z"� -� O +r �"='�1^� �� `� • �� .
City/Zip JVC"-\U-1 v r.
If in Subdivision provide information, as follows: �E e
Name: PC.� Zrb dQ cg—,A undew. bpd linxi on
.� ht o a t Cr; I o n•
Section: Lot #: /� S (,5
This is to certify that the information provided is correct to the best of my knowledge. I understand that anyjpermit(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 Dade County Health Department to enter upon above described property located in Davie County and owned
by rtinonduct all -testin pro aures as necessary to determine the site suitability.
DATE `� a 1, SIGNATURE \
Revised DCHD (06-96)
THIS A1ZEA MAY 13E USED FOR DRAIVINQ fOU1; SITE PLAN:
�a -7
1 --
IS �
j APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
" Davie County Health Department - ........... , I
' Environmental Health Section61�
P. O. Box 665
Mocksville, NC 27028 JAPE ® 1995
1. Application/Permit Requested By. /
Mailing Address 5 0 f (�/ , C(eyv./vw,�S v, l Home Phone q/q) 79-77US
b-457- N.C. Z-1 I Z Business Phone Vrkftir7�� 0
2. Name on Permit if Different than Above
3. Application for:
El General Evaluation R'Septic Tank Installation Permit
4. System to Serve: ETHouse
❑ Business ❑ Industry
5. If house, mobile home: Subdivision C�� �ev� (5r:Ay-
No. of People 3
No. of Bedrooms 3
No. of Bathrooms
Z
❑ Mobile Home
❑ Other
Dwelling Dimensions 120o ^
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
❑ Place of Public Assembly
❑ Unknown
Section Lot # ID
❑ Basement/Plumbing
❑ Basement/No Plumbing
O'Washing Machine
❑ Dishwasher
❑ Garbage Disposal
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers _ Water Usage Figures
/
7. Type of water supply: I� Public�ir I El Private El Community
H
8. Property Dimensions /�� X " K KO')( 395 Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 0'No
If yes, what type?
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
'ro rr Fo r le -
�ax� fv 6,^e��t �'Y'ra►/'I Io-} ; s 700'
an�-
This is to certify that the information provided is correct to the best of my knowledge, and I understand I
incurred from this application.
/-3v-957— — -A =:n� �- a -
DATE SIGNATURE
responsible for all charges
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. V2. I DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of theavie County He th Department to enter ,upon lve described
property located in Davie County and owned by c�2,_,,,, U"t✓` �et✓S ��S - �
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
/-50-q� a -"A -7k -
DATE SIGNATURE
DCHD (1/93)
�. DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME /%�. �l�T DATE EVALUATED a�9S
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY /VdGtS e LOCATION OF SITE
Water Supply: On -Site Well
Community
Public [-`�
Evaluation By: Auger Boring // Pit Cut
FACTORS
1
2
3
4
Landscape position
G
L
L
Sloe Z
y
4_1
y
HORIZON I DEPTH
' '
''
Texture group
11? G,
L
1.4
Consistence
Structure
Mineralogy
HORIZON II DEPTH
/'
Texture group
Consistence
Structure
S6�c
S k
Mineralogy
_ /
l `l
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
3
,3
SITE CLASSIFICATION: EVALUATED BY: /ial a
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
SILL -Silty ;lay 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 (01-901
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Daure County NealtFr Department
and .poke Nealt§ Ayeney
210 HOSPITAL STREET/ P.O. BOX 665
MOCKSVILLE. N.C. 27028
,PHONE: (704) 634.5985
K
February 14, 1995
Timothy A. !Biller
2501 W. Clemmonsville Rd.
Winston-Salem, HC 27127
Re: Site Evaluation
Greenbriar-Lot 10
Dear hr. hiller:
As requested, a representative from this office visited the aforementioned
site on February 6, 1995, Based upon the information provided on the
application for.site evaluation and after the evaluation was completed, the
site was found to be provisionally suitable for the installation of an on-site
sewage disposal system.
If you have any questions, please feel free to contact this office.
Sincerely,
'0 ,z 1.4? 1�7
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd
Enclosure