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HomeMy WebLinkAboutRBPR-03-2016-23538.TIF 44.1v,A co \ THIS IS NOT A PERMIT Case # RBPR-03-2016-23538 u " !A; CATAWBA COUNTY HEALTH DEPARTMENT 505 . e .f O PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r+ ' i rfr �84Z �� Residential Building Plan Review - Manufactured Home '�o • ris r a f� r r 9-06-Ye AUTH_CONST - NEW WELL •�4) Contact Person AKWOOD HOMES #712 (ELIOBERTO ALFONSO), 1265 70 HWY W,NEWTON NC 28658 B:(828)217-1862 C:(828)464-2662F:828-464-430 I R712 @CLAYTONHOMES.COM Contractor *OAKWOOD HOMES #712 (ELIOBERTOALFONSO), 1265 70 HWY W,NEWTON NC 28658 B:(828)217-1862 C:(828)464-2662F:828-464-4301 R712cICLAYTONHOMES.COM Land Owner TED URCINOLA, 2238 SIGMON DIARY RD, NEWTON NC 28658 Owner RON BUCHANAN, 3508 LEAFWOOD LN, VALE NC 28168 H:8283107819 HOME:8283107819 NAME TO APPEAR ON PERMIT Ron Buchanan SITE ADDRESS: 3508 LEAFWOOD LN, VALE NC 28168 PIN # 269702884151 NAME of SUBDIVISION: LEAFWOOD Lot 20 Section/Block PROPERTY SIZE: Square Feet Acres 0.63 DIRECTIONS: 70 west-TL 127 south-TL on Leafwood Lane- Lot on left. PRIMARY CONTACT: Contact Person SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New 28 X 56 double wide w/decks: front & back 6x6 2016 class A ** Must have min 36 sf deck on front ** Must be parallel to road ** Must have Masonry Underpin ** Must screen or remove towing tongue. SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES', then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? No Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 0 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: DW 28x56, Decks: front& back 6x6 #OF NEW BEDROOMS:: 3 Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO IN-ehapplic,thon 04/01/2016 08:48 Page 1 of 4 CATAWBA COUNTY Case'! RBPR-03-2016-23538 Q mil. Public Health Department Subdivision LEAFWOOD Q "I Environmental Health Division PINIk '� c 269702884151 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 1g.2 s. NAME ON PERMIT: ( RON BUCHANAN), 3508 LEAFWOOD LN, VALE NC 28168 ( Ron Buchanan) Site Address: 3508 LEAFWOOD LN, VALE NC 28168 Property Size: Square Feet Acres 0.63 Directions: 70 west-TL 127 south-TL on Leafwood Lane- Lot on left. Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 Ei.,l` �t 's§�k Fi�a sc-- 2 s--s a qz ir,. iga'.. "' f v cr"s ra [-GEE ENAMFh 4 3t>° LTyrii:iiK(-L tri rt.L_ru(.r. rDATE to fFEE-AMOUNTi;!y Authorization to Construct Fee (New/Expansion) 03/31/2016 $150.00 Fee Well Permit& Inspection Fee 03/31/2016 $300.00 rg i..?vrrymP�°`°`,°''-1TOTAL,FEES!: !E;rlFti 'j ti i d :"f di{� ,!�•`�'�i 4 r '1=:l:o.i£';;_' `- v$4'56:b6,1111 F ��y�i r k.�` x H,a u v v �r :.. t �,..». P„..«........�. .. .....tu.0 s...u.......4-;d�.....i...6t(.,aa." 'S8 I�..�.a.h i Y t'- .t"uv'iiL_.3 nemt E` FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 19-ehapplicaiion 04/01/2016 08:48 Page 2 of4 �$A �� THIS IS NOT A PERMIT Case # RBPR-03-2016-23538 0 y 0 CATAWBA COUNTY HEALTH DEPARTMENT q ti r �o { PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES P ' \84��y SM Residential Building Plan Review - Manufactured Home oft a h AUTH_CONST - NEW WELL .Da' '- �_ ;}: Applicant RON BUCFIANAN, 3508 LEAFWOOD LN, VALE NC 28168 H:8283107819 1-10ME:8283 1 078 19 Contact Person *OAKWOOD HOMES #712 (ELIOBERTO ALFONSO), 1265 70 HWY W,NEWTON NC 28658 B:(828)217-1862 C:(828)464-2662F:828-464-4301 R712c@iCLAYTONHOMES.COM Contractor *OAKWOOD HOMES 4712 (ELIOBERTOALFONSO), 1265 70 HWY W, NEWTON NC 28658 . B:(828)217-1862 C:(828)464-2662F:828-464-4301 R7I2 @CLAYTONHOMES.COM Owner TED URCINOLA, 2238 SIGMON DIARY RD,NEWTON NC 28658 NAME TO APPEAR ON PERMIT Ted Urcinola SITE ADDRESS: 3508 LEAFWOOD LN, VALE NC 28168 PIN # 269702884151 NAME of SUBDIVISION: LEAFWOOD Lot# 20 _ Section/Block PROPERTY SIZE: Square Feet Acres 0.63 DIRECTIONS: 70 west-TL 127 south-TL on Leafwood Lane- Lot on left. PRIMARY CONTACT: Contact Person SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New 28 X 56 double wide 2016 class A ** Must have min 36 sf deck on front** Must be parallel to road ** Must have Masonry Underpin ** Must screen or remove towing tongue. SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? No Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 0 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION #OF NEW BEDROOMS:: 3 Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9-chappl ication 03/31/2016 17:10 Page 1 of 4 �8A CATAWBA COUNTY case# RBPR-03-2016-23538 Public Health Department Subdivision LEAFWOOD i is i� Environmental Health Division PIN# 269702884151 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 IS 2 m NAME ON PERMIT: (TED URCINOLA),2238 SIGMON DIARY RD,NEWTON NC 28658 ( Ted Urcinola) Site Address: 3508 LEAF WOOD LN, VALE NC 28168 Property Size: Square Feet Acres 0.63 Directions: 70 west-TL 127 south-TL on Leafwood Lane- Lot on left. Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application,site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 ............................................................................................................ FFENAME DATE r ' FEE AMOUNT, Authorization to Construct Fee (New/Expansion) 03/31/2016 $150.00 Fee Well Permit& Inspection Fee 03/31/2016 $300.00 TOTAL FEES ' .' `: . .' ;.; $450.00....,. ll FEES ARE NON-REFUNDABLE ONCE A SITE VISIT 15 MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) • E9-chappl ication 03/31/2016 17:10 Page 2 of 4 PERMIT Li COUNTY �� CATAWBA u COUNTY HEALTH DEPARTMENT w,,,,,c Application for Environmental Services Page 1 Improvement Permit, Authorization to Construct i$ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit Replacement Well ❑ Well Abandonment❑ l r Well Repair ❑ Existing Syst m Inspectio���n (Pre-Approval Required) ❑ �,.ec . �r l ,\5 Application is for New Construction L Existing Facility ❑ ��t t C' Property Address V L-c- . d / Cr,Q o� /Subdivision c [U ,Q�/ BPD Lot# Acres Section/Block/Phase Driving Directions to Property -1 O C4J�5-I-- - 7-1 I a.77 < nLL 6t.- TL U n n • - NAME TO APPEAR ON PERMIT? Mater ❑ Applicant ❑ Contractor Applicant Contact Information f Name QrKWU( Hrorives os _ ink_ \ \ Address 1 0 C jAc_ `—t C) — �it° W� �� D��( o e Phone 4.4Lc,4 LQ�a Cell Phone Owner Contact Information Name r<n ru, rt_,_C kc na n Address Le G�-Vl .v-Ocl I xz-lc - l ) L€ i3C- cQ� Phone SSr�' -`3 i0-12 i 9 Cell Phone Contractor Contact Information Name 'SG wLP c s c l L < on'- Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? XOwner ❑ Applicant ❑ Contractor Description of Existing Structures on Site #of Bedrooms *t Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures Q Yes ®No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. El Yes *Ao Does the site contain any jurisdictional wetlands? Ali CI Yes •• o Does the site contain any existing wastewater systems? ❑Yes ■-.o Is any wastewater going to be generated on the site other than domestic sewage? -*Yes 6%o Is the site subject to approval by any other public agency? C Yes (o Are there any easements or right of ways on this property? Describe Existing wa/ter supply in use U Individual Well U Community Well U Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes [ Io If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of o preference) ❑Accepted ❑Alternative conventional ❑ Innovative ❑ Other ❑ Any b/ t 910E-DE-£0 'W'e 1716560 ZIOHW 10E1479% CAT' A AWB THIS IS NOT S�,) ERMIT J Et COUNTY 17 CATAWBA COUNTY HEALTH DEPARTMENT ,,,,,„�,,z-- Application for Environmental Services Page 2 _( G2 Pr posed Facility Type lj Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *t. Project Description _se ,� ,✓ 7 n PL, 5 c3/40U0(ew Ae rnObi. t< Korn e Structure Dimensions 2YR 1t S� #of Occupants —S Basement ❑ Yes 4 No Basement Fixtures ® Yes r.Plo U Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑No Plumbing ❑Yes ❑No Describe Plumbing Needed U Multi-Family Residence #Units #Bedrooms per Unit*j' Total#Bedrooms *t Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area (Sq. Ft.), U Business Specific Type of Business Retail Floor Space #of Employees per Shift #of Shifts ❑ Other Facility Type Specify If Church#of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair • Proposed Well Type Indivi _ dual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type /❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on-site staff. Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications.The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. t If structure is plumbed but no bedrooms, calculated design flow is required. **If No,a well permit must be issued with the Authorization to Construct SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5) five years from the date issued and is not transferable;Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. �� 2 30"-ti Signature of Owner or Agent Of.. a 1_I�4 • .V\ t. ASS `I / /� Printed Name of Owner or Agent\ � NQ,. YY\t7.n —ff}r l y`-t�WUC9 t Ti Crlecs v/Z 910Z-0£-£0 WE 62:6S:60 ZlLDHIN l0£1219178Z8 CATAWBA Geospatial Real Estate Search _ l Information Services VO t� A c Nom NN NINNSNe No.,...-cceswaed# I i III w+e 1 in=75ft Parcel: 269702884151, 3508 LEAFWOOD LN VALE, 28168 Owners: URCINOLA TED ALLAN, URCINOLA KATHY FOX Owner Address: 2238 SIGMON DIARY RD Values - Building(s): $0, Land: $12,000, Total: $12,000 This maplreport product was prepared from the Catawba County,NC Goospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling Information contained on this map or data on this report Catawba County promotes and recommends the Independent verification of any data contained on this map/report product by the user.The County of Catawba,Its employees,agents,and personnel,disclaim and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 03/30/2016 Et 910Z-0E-€o 'lire 55:00:1 2 IOHIN l0EVV928Z8 Catawba County Environmental Health hti 0 1 1 9154 N.); 4.,cp In ,aa 255.33 '1 " u 86.35 —'IOU "d ''air 70 .28T 1 1 j •0 te * ,E- tea., 158.28 x 3 ' 66 7 �r1 v ii i A.244.4,d § 1"S\. 1 i.34 C _ ._.. Parcel: 269702884151 , 3508 LEAFWOOD LN 1 in=50ft VALE, 28168 This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba, its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 03/30/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 269702884151 Owner: URCINOLA TED ALLAN Parcel Address: 3508 LEAFWOOD LN Owner2: URCINOLA KATHY FOX City: VALE, 28168 Address: 2238 SIGMON DIARY RD LRK(REID): 700724 Address2: null Deed Book/Page: 2887/0230 City: NEWTON Subdivision: LEAFWOOD State/Zip: NC 28658-8655 Lots/Block: 20/ null Last Sale: School Information: School District: COUNTY Plat Book/Page: 52/59 Legal: LOT 20 LEAFWOOD PL 52-59 Elementary School: BANOAK Middle School: JACOBS FORK Calculated Acreage: .630 High School: FRED T FOARD Tax Map: null School Map Township: JACOBS FORK State Road #: null TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: PROPST Zoningl: R-40 Building(s) Value: $0 Zoning2: null Land Value: $12,000 Zoning3: null Assessed Total Value: $12,000 Zoning Overlay: null Year Built/Remodeled: null/null Small Area: PLATEAU Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710268600J Building Details 2010 Census Block: 4014 WaterShed: null 2010 Census Tract: 011802 Voter Precinct: P3 Agricultural District: PROXIMITY Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents.and personnel,disclaim,and shall not be hold liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. II ©2016, Catawba County Government, North Carolina. All rights reserved. 021 jrktifil aco Sots/%%%, http://gis.catawbacountync.gov/nomap/parcel_report.php?key=269702884151&typ=P 3/30/2016 ,-: i.: si>,. !.A CATAWBA COUNTY D;?�; .b� Case# iNiPV-07-2016-07048, .;ail1 Public Health Department ?•.:.:11—r, • `... Subdivision LEAFWOOD d Environmental 389, Hcahh Division ;3 : Pi NI? 269702884151 °•7 { 1.117/ 20 `d' PO Box 389. I(i0-A Southwest 13hd, Newton.NC ?8658 '• i• , err. NAME ON PERMIT: RON BUCHANAN, Site Address: 3508 LEAFWOOD LN, VALE NC 28168 Property Size: Square Feet:27,442.80 Acres:0,63 Directions: 10 W, left on Plateau Rd, left on Leafwood, lot 20 on left Improvement Permit Facility: Primary Residence Permit Category: New Septic Bedrooms 3 WATER SUPPLY: Private Well Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years ^X_ No Expiration: Projected Daily Flow 360 g.p.d Proposed Wastewater System: 25% REDUCTION Type: IIIG - OTHER NON-CONY TRENCH SYSTEMS Permit Conditions: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 25% REDUCTION Type: IIIG -OTHER l TER NON-CONV TRENCH SYS'T'EMS Landscaping or other site alterations that potentially dived groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains, is not approved, and may result in failure to approve the initial system installation,or the suspension/revocation of existing permits. The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility at the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are mut. This Improvement Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'LOW%and Rafesfor Selene Treatment and D/sirual Sl:aems' (I5A NCAC ISA .19(10). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Steven Price 03/28/2016 Al)ft1ORIZED STATE AGENT APPROVAL DATE 03/25/2021 Permit Expiration Date: No grading or eortcuvreliat activity is allowed in areas c(e.signuler(for system and repair without approval of the Health Department. chhxrmit 03/29/2016 11:18 Pape t ot7 EHPR 03-2016-23312 3508 LEAFWOOD LN, NEWTON • Do not cut, drive, fill, or grade over septic or repair areas. • This permit is not intended for septic installation purposes. l ciu.sc n- - .+...^ LA- i-■ 'h-cN 40-:,,i Si't ✓tc,t Ucck of M.6, 1. G,... . c.,,,.{- n..o.... {t,—, 70 cet.4_ F,, yr ' Fond 9tafct4, (C2, a r �a k GS V � c8 i ti v 4. r .9 .i' ge:LA-... - Sys it-,-, .' /i N (Z to, 2i8„ " ss- y ° #s ,x% 4,-. t"yt e,,,, DEPARTMENJ OF HEALTH AND HUMAN SERVICES -tee 03-2,(6- 'Z3,5I2 Sheet ( of 7 DIVISION O(:PUBLIC HEALTH,ENVIRONMENTAL HEALTI1 SECTION PROPERTY ID N: ON-SITE WATER PROTECTION BRANCH COUNTY: Cc(----4 SOIIJSITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Cumplcie all fields in lull) OWNER: gl g-cie'^`^ APPLICATION DATE ADDRESS: JSD& (...c<.i,�s..3,) L. ✓`O DATE EVALUATED: PROPOSED FACILITY: 3 a!' PROPOSED DESIGN FLOW(.1949): PROPERTY SIZE: LOCATION OF SITE: PROPERTY RECORDED: WATER SUPPLY: ❑Private ❑Public Well ❑ Spring ❑Other EVALUATION METHOD: ❑Auger Boring LXPit ❑Cut TYPE OF WAS'T'EWA'T'ER: eiSewage ❑Industrial Process ❑Mixed • ♦ ♦ 6 ♦ P o SOIL MORPHOLOGY OTHER F (.1941) PROFILE FACTORS t .1940 F LANDSCAPE HORIZON POSITION/ DEPTH .1942 PROFILE q SLOPE% (IN.) .1941 .1941 SOIL .1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE/ NVETNESS/ SOIL SAPRO RESTR &LTIR TEXTURE MINERALOGY COLOR DEPTH CLASS IIORIZ C) - 25 56 k. C r- S>;' �A GS 2C" Y8 "53kk CL it ^ Lig ,v f 0.2 1 % u/s,.� r..--_i< • D -4 20 s6ic ct_ Fit .SC LS /�� s c ,ilA- 33 ■itf-- Al A- (S 0. 271 2 to z B— Lfg gck • D -8 flak ScL fe se- 3•0,. yf5 Q- -36 S6k c r e SCr Y-t(. N� ✓k n A- IS ® ft 3L- 70 ' e C F, ...5C /z 0, 27S- 564 0 -Z3 SdL c /'-e Sc_:,-- Nfr PS 3 r5 23 -6j +l S6 k_ CL se e, 6T n riff/k f 0 j'6 Yeti.-I • o. 27-3— rr-Fc u,1,?c 140 WC% DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): Available Space(.1945) es Ps SIFT',CLASSIFICATION(.1948): /1 VALUATED BY: 6-f„ t^`4 System TrpeD) 2-it tit - 2c?‘ 4-1 o'rrle.R(s)PRI.SI MI_. __ Site LTAR q. 2.7j O. 27( COMMENTS.