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HomeMy WebLinkAboutEHPR-08-2016-24590.TIF �Y THIS IS NOTA PERMIT Case # EHPR-08-2016-24590 rt Fer CATAWBA COUNTY HEALTH DEPARTMENT 0 'w•t 0 U 'gc•a► . S fir- \4 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES - 1842 s�� Environmental Health Plan Review - OSWP 'o - '4 • IMPROVEMENT •4•f Jo, '. Applicant THE OAKS GROUP, PA (KATHLEEN SAUNDERS), 121 HOLT LN, MOORESVILLE NC 28117 C:704578495I Land Owner CAROLINA CENTERS LLC,227 W TRADE ST STE 1000, CHARLOTTE NC 28202 Owner BLUESHORE DIRECT INC, 16415 NORTHCROSS DR SUITE B, HUNTERSVILLE NC 28078 C:7048978500 NAME TO APPEAR ON PERMIT Blueshore Direct Inc SITE ADDRESS: 3693 CHEVLOT HILLS RD, SHERRILLS FORD NC 28673 PIN # 460702754550 NAME of SUBDIVISION: Lot# 3 Section/Block PROPERTY SIZE: Square Feet 47,044.80 Acres 1.08 DIRECTIONS: Hwy 150, Left onto Cheviot Hills Rd, Lot is on the Left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only* 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? No Are there any easements or right-of-ways on this property? Yes Property Easements Description: Supply line easement for Lot 4 APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 6 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 50x40 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehupplicnunn 08/25/2016 09:20 Page 1 o14 (ii_A . CATAWBA COUNTY case;l EHPR-08-2016-24590 L Public Health Department Subdivision ,� Environmental Health Division PIN# 460702754550 4 ,, 7 PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 84 NAME ON PERMIT: BLUESHORE DIRECT INC ( ), 16415 NORTHCROSS DR SUITE B, HUNTERSVILLE NC 28078 Blueshore Direct Inc ( ) Site Address: 3693 CHEVLOT HILLS RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 47,044.80 Acres 1.08 Directions: Hwy 150, Left onto Cheviot Hills Rd, Lot is on the 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 a d labeing of all property lines and corners and making the site acc ss ble so that a comple site evaluation can be performed. Date: g as I (o 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 AREA1 FTAIMIIIIIRI ' Tj 11'(111, 1;1"i'ri11,gr,: r r� "7�11 I—`'i�g11i'I 3 8111h1 ELLFEENAME +ivl���lr ,u. -_ ..- , I„�IDATE-' I.�,y__FEEsAMOUNTIII Improvement Permit Fee 08/25/2016 $150.00 11I� i till.11'i' TOTAL, E ES . ,t + zli . '111141111111),':-It.' (IaiIIlIS1500P.. ` 1r111 "tumult',i n m, 99-61111M11111011111111111i . 'Uth4/ '111P11:11GWWUalllll2hl ` FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-chapel ication 08/25/2016 09:20 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT ZHCO cot�„ CATAWBA COUNTY HEALTH DEPAR TS k -14csar. Application for Environmental Services Page 1 Improvement Permit Authorization to Construct Septic Repair E Septic Malfunction❑ Septic Expansion J New Well Permit Replacement Well Well Abandonment E Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction Existing Facility ❑ Property Address (,hc.,l/I01 I-111 Is Ed Subdivision N/n Sherri 11S Forrl , 2$,Z? Lot# N/ri 3 Acres /• 08 Section/Block/Phase N Driving Directions to?ropetty {-4wy 1SQ, Left on C17evIOt Ff Its f0 On ta'r't" NAME TO APPEAR ON PERMIT? CR) Owner ❑ Applicant U Contractor Applicant Contact Information Name Blue S hone Dived Irtc Address 1(04 IS NOr,4hCrnsS ta- Stu to B Marta svi I k NC Phone log- 'ch—?SOo I Cell Phone Owner Contact Information Name ,Sann< at pp P GC cin 4- Address Phone Cell Phone Contractor Contact Information Name - al-kt\een Saunders /Emrna Helton Address 1 21 14o 1-f Ln to noresv i/I C NC 28// 7 Phone Cell Phone 709_5 7g-e/qs� WHO WILL BE THE PRIMARY CONTACT? ❑ Owner IT Applicant Contractor Description of Existing Structures on Site 14114 # of Bedrooms *f Structure Dimensions #of Occupants Basement ❑ Yes 5 No Basement Fixtures Yes ;0 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. D Yes igtNo Does the site contain any jurisdictional wetlands? Yes Wv'o Does the site contain any existing wastewater systems? F} Yes 0-No is any wastewater going to be generated on the site other than domestic sewage? ® Yes VI\lo Is the site subject to approval by any other public agency? C Yes ti'No Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well H Community Well H Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** 5 Yes 5 No If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any CATAWBA A TA`s BA THIS IS NOT A PERMIT C.x N Y 8YY A] CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type S Primary Residence Nj New Residence n Addition to Residence # of New Bedrooms *j' 3 Project Description S'F2. Structure Dimensions 50'k 90' # of Occupants (o max Basement El Yes IX No Basement Fixtures ® Yes _►: No Li Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling _ Yes [ No Plumbing ❑ Yes ❑No Describe Plumbing Needed Multi-Family Residence ft Units #Bedrooms per Unit*t 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.) 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 ❑ Individual Well n Semi-Public Well ❑ Community Well Abandonment Type n 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 plunibedbut 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. Signature of Owner or Agent / ' Date 8/2 //(o Printed Name of Owner or Agent Emma, I-eR0 n OC V.VJV'fl4$L. ..\ JLr I.V y n.y•./ tEL Cr 4607-0275-3876 ;ARY S. TAYLOR & ,`I ,— as ;AND'RA B. TAYLOR 0.6. 1765 PC. 845 113") Cl I )T #136 P.B. 15 PC. 186 — -"' ii y 5' N 1 �• . ' 11 ),y1.7. p Ji4 Or 0 i1dw Ty• 2 ' N 7. 4 1 N�1851:' e" (Et: : Jo\ \ lr 140' .'-.d PORTION Of PA; r CcY\ t5L �, \ AREA -ORTION Of PARCEL ID 4607 -45 AREA IN (INCLUDING D.97: 1.34 �t� SEPTIC (TO 8E REC• `` •3 AREA = 1.080 AC• = R' EASEMENT . OF PARCEL - 7 =0.021 ACRE u ' ASO SSB' CMP ta' I i1 w 3T \ L U 1: -C4L ry 11 J i a S > a DUKE ENERGY W� ;G 3 LAKE NORMAN r, AREA IN \- �,g, G w, �, SEPTIC 4y �' I' l A EASEMENT =� [s <� 120 0.038 ACRE �, '� S.wfps T680 3(TOT PLS _ R. l 105.02 : r.; 05.04') , / ro 00. II 1 J (159.481 ' N NEW LOT #4 I ! PORTION OF PARCEL 10 4507-0275-4550 c ' a , •• ! 6 r AREA = 1.045 ACRES a 1 (INCLUDING 0.021 ACRE IN RAILROAD VW) ! / (TO 8E RECOMBINED WITH PORTION I u OF PARCEL IO 4607-1275-6075) ' ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Sheet_of DIVISION OF PUBLIC HEALTH.ENVIRONMENTAL HEALTH SECTION PROPERTY ID it: ON-SITE WATER PROTECTION BRANCH _ COUNTY: SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Complete all fields in full) OWNER: _ APPLICATION DATE ADDRESS: DATE EVALUATED: PROPOSED FACILITY: PROPOSED DESIGN FLOW(.1949): PROPERTY SIZE: LOCATION OF SITE: 'Ai, t!' - PROPERTY RECORDED: WATER SUPPLY: 0 Private 0 Public 0 Well 0 Spring 0 Other EVALUATION METHOD: 0 Auger Boring 0 Pit 0 Cut TYPE OF WASTEWATER: 0 Sewage 0 Industrial Process 0 Mixed r SOIL MORPHOLOGY OTHER s (.1941) PROFILE FACTORS .1940 LANDSCAPE HORIZON PROFILE POSITION/ DEPTH 1942 SLOPE% (IN.) .1941 .1941 SOIL .1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR &LTAR TEXTURE JIINERALOGY COLOR DEPTH CLASS HORIZ scf- c ( i s7 . DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): SITE CLASSIFICATION(.1945): AvailableSpace(.1945) EVALUATED BY: System Type(s) OTHER(S)PRESENT: Site LTAR COMMENTS: Updated February,2014 Catawba County Environmental Health (141 ' 1lif rr k II,ekti11,I. r 7 (LI L. p4I` 'i I rillr �" All'I kll ��' � ;y11,,nh�" ' r44. (42) Ct r ` ' i l�'f i `� ill i. ,r1:11r1011ii, II ,,�1riii1 ----______Ji: ,.,,b., Ohl,1 , CiI. l I 14 l iktik4lll il* ilit ISII 4 fii ij)silk Wu', ri. r��l��I I I� lye'1,ll sfifk ra fil I I Si IS 1 11)„, .w";II 1 1, lii'titrf . i �ilhw.21_A38Iiyll� 'iIbi,, "' Il F + ' ` r8, Ir , etre / _ or �l��t„) k(� IryI'�f �I� I�111 63r I h i 11 l�fafy” � MIWilllllr .,:i tai,-Vi IY •Ili + ia, t w t'nu' V. 12.43 1 .Ids. __ e4,1 ,,r4 IIN I1��� �P 1I1� III' 11 i i l ll.n r`,...I ' .3 2019 2 :. �IUti 1IIiiir 4 , LP, 1I ���lBib 30.9 9 �" 4uii'" '" liriThd6:-', Q,0 �', 1 4 ii v. di nt 1 ii d Ili 01014160, tiii:1 ' :....4:10,p08 13 i 8.66 h 1 .97 Sip I��lb4�iliiii;14"., S . 1 I•..9 'CO --. ''• 4, 6, 21 04 I 1697 1b4ili I N „` t-' 16.29-----..,J)Wag CC 1 • `I ° ) 73 / // 11 / 182.-4'6^'''' 25. (.2)-� / / Parcel: 460702754550, CHEVLOT HILLS RD 1 in=80ft SHERRILLS FORD, 28673 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 08/25/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460702754550 Owner: CAROLINA CENTERS LLC Parcel Address: CHEVLOT HILLS RD Owner2: City: SHERRILLS FORD, 28673 Address: 227 WEST TRADE ST STE 1000 LRK(REID): 803689 Address2: Deed Book/Page: 1898/0427 City: CHARLOTTE Subdivision: State/Zip: NC 28202 Lots/Block: / Last Sale: School Information: School District: COUNTY Plat Book/Page: 74/164 Legal: PL 67-105 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: 2.110 Tax Map: High School: BANDYS Township: MOUNTAIN CREEK State Road #: 1985 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $4,200 Zoning2: Land Value: $59,100 Zoning3: Assessed Total Value: $63,300 Zoning Overlay: CRC-O,FPM-O,WP-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: Building Permits for this parcel. Firm Panel #: Building Details 2010 Census Block: Watershed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P31 Agricultural District: 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 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. ©2016, Catawba County Government, North Carolina. All rights reserved. i\LCO3 Adak% 0. 36„q-3 Opoikst- 1-ii �- 3 http://gis.catawbacountync.gov/nomap/parcel_report.php?key 460702754550&typ=P 8/25/2016 $ * CATAWBA COUNTY lk .1 100A SOUTHWEST BLVD '�i',', t NEWTON, NORTH CAROLINA 28658 RECEIPT ,r-77 rvucip r----t-i$ Hpmq,� ��,� PHONE: 828.465.8399 Thursday, August 25, 2016 1842 sn+ www.catawbacountync.gov PAYOR: The Oaks Group, PA The Oaks Group, PA(Saunders, Kathleen) PAYMENTS TRANSACTION NUMBER: TRC-799400-25-08-2016 PAYMENT DATE : 08/25/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331997 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-08-2016-24590 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3693 CHEVLOT HILLS RD, SHERRILLS FORD NC 28673 Applicant THE OAKS GROUP, PA, 121 HOLT LN, MOORESVILLE NC 28117 C:704578495I ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Land Owner CAROLINA CENTERS LLC, 227 W TRADE ST STE 1000, CHARLOTTE NC 28202 Owner BLUESHORE DIRECT INC, 16415 NORTHCROSS DR SUITE B, HUNTERSVILLE NC 28078 C:7048978500 receipt 08/25/2016 0919 Page I of 1 -3.5i., CATAWBA COUNTY /,'.° t ,Public Health Department -Case# W LS2007-01042 I Environmental Health Division Subdivision CAROLINA CENTERS LLC \\ ,/t PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 Sect/BIJPh/Lot# '5.,.: (828)465-8270 FAX(828)465-8276 TDD(828)465-8200 PIN# 460716832252 Applicant/Owner CRESCENT RESOUCRES, INC. //�� Site Address: CHEVLOT HILLS RD /7OSIGCi Cc Property Size: SF 1.173 ACRES IY Directions: HWY 150 TO CHEVLOT HILLS RD Improvement Permit Permit Valid For: Five years ✓ No Expiration p Facility(Residential): House v House X Mobile Home Multi-Family Bedrooms 4 New? 07--Addition? Projected Daily Flow no g.p.d Water Supply Private Well? ✓ Public? Semi-Public? Basement: Y Basement Plumbing: Y �otHotTubb//SppaN� Special Fixtures(explain): Proposed Wastewater Syr em: �m�ow,- ref tyV 11/,IPP 41 '4! '7/,' _ Type: V—� Proposed Repair: a' v sas r j Z/' /' ,.7_, /t w •Permit Con di ns: •j d±' _ . c -S•' ,... re^. or t i i / y/y_ _ _ = . • �B.c n. �. ..V/Sv a� ..— e . e • n a vie/- t:!_' „ Owner or Legal Representative Signature: . � c-M4 Date: 09/ 24/07 Authorized State Agent: /2ej./�S _-_..____ Date: 9 r 2,f ._a7 The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements arc met. 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 'Laws and Rules for Sewage Treatment and Disposal Systems' (15A NCAC ISA.1900). 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. Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and additional attachments( ). Proposed Wastewater System: Type: Wastewater Flow g.p.d New Repair _ Expansion Soil LTAR: g.p.d./ft2 Type of Facility: Basement: Y Basement Plumbing: Y HotTub/Spa: N Special Fixtures(explain): Wastewater System Requirements Tank Size: Septic Tank gal Pump Tank gal Grease Trap gal Drainfield: Total Area: sq ft Total Length: ft Maximum Trench Depth in Trench Width ft Minimum Soil Cover in Minimum Trench Seperation ft Distribution: Distribution Box Serial Distribution Pressure Manifold LPP Other Additional Specifications: Authorized State Agent: Date: Permit Expiration Date: /have read and accept the specifications and all conditions of this permit as indicated. Owner or Legal Representative Signature: Date: Form II rATBlanuc0PnouVrvLAnm.ivi de((, • \ CATAWBA COUNTY -� �2' \ Public Health Department Case 4 WLS2007-01042 /✓` 1-' Y \\%�� Subdivision n,(L� .I Environmental Health Division CAROLINA CENTERS LLC \\ACL".// PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 Sect/BL/Ph/Lot 4 �:::—,-(,.../ (828)a6S-8270 FAX(828)465-8276 TDD(328)468-ft200 PIN# 460716832252 Applicant/Owner CRESCENT RESOUCRES, it Site Address: CHEVLOT HILLS RD Property Si SF 1.17 ACRES Directions: HWY 150 TO CHEVLOT HILLS RD dy Improvement Permit III Authorization To Construct El Well Permit SITE PLAN g -v375 i 1 / 1 fro' d tar,- lecf.- vie PP,313 q //// a • 1 Y ti 15' RIM--`. rhe- h / 1.-7114- ..-to...s N/ urian v / =-CD / Scale System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not install system under wet conditions. This permit is subject of revocation if the site plan or site conditions are altered. A/ Vis: P-120-07 Authorized State • gent Date Form C r:aidernar h,,mNwLAum.,m { • "- et 573-$2 J _ //��'' 9p j9 cc �z G• o� vv r r z O . •� 1 I- zK - ,�;� ry z OO 0 to V U _ W i 1J' L 0 \� \n 4 WELL I.....1 IM St-7E I 52', 13 �. m o a m� s \5+ I Gb� ,� - n r ¢I,-co , m° o 5-10.1 ill v ..----"" ' qa .. , Qac+a.��. oe, Lil 4 " / t ` . 3 nza0 I ca '� ^'' 43 Li 'it 3 N IU A n-toN • /�.h I ; 0 01 • • �crn r O r( 1 O _ ' 0���: dao�z S e . `JY 0 j \ pv 0 �7 `� >ti 0 qh. .r ee 15_ Tv GAvAL .,- .-506.1 �rozo a Cs 1 .. �` . ado riu: 61 r rl Sax '. Um 'o z 1 I • wr P �� y i z yyw 0. 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SOIL SITE EVALUATION • for ON-SITE WASTEWATER SYSTEM )WNER: Cil o5i P_ry ?„,eft _ APPLICATION DATE ,DDRESg: DATE EVALUATED: ROPOSED FACILITY:-Y: 't af... S PPOPOSED DESIGN_ FLOW(.1949): . U Ce b PROPERTY 3126: OCATION OF arm: 1.6 t I g', C Ke v(c b )-N I I s , PROPERTY RECORDED: /ATER SUPPLY:)(Private ❑Publlo )swan 0 Spring ❑Other • :VALUATION METHOD: Zustv Borten t ❑CK TYPE OF WASTEWATER: ❑Sawo 0 Industrial Proc , ❑Mixed r R SOIL MORPHOLOGY won r Gam) PROFIIi FACTORS T .IfN L▪ LAlift'4fl RCIBRE014 , • SAf6% .4D'y' . .HU .00 - Som: . aro JARS .UM a.65t STRUM= OONSQ1TflDlr *mass/ SOI. SASt) Runt S LTAR .Turromt wastA1.OGY- coma Dwu CLASS =M . _ o - to wk,5bk5cC RJp CS/ d %s-wn.) r QS R111---Z— L C —30 1"10/14 40)(.5C 6,Fr,S5i5?((8ry -Red) .73O 1 1G-7i{°, 4. 3d -�{.� W{( 51-)1Ci c fr1 csy'.��$r ;,.t) I Lis-- 4 mass./SL/L �. SS+rvi i Y�la)4O s D- ((o • Mo5k LFrSS5PCBr >„) �, L 16 -v5 -ak(5b.k1sc`/sc. p,-51,sf O 1,� wy 54P, tt chis, 0, 30 -- '�- I8/: 0, 35- . 0 - (o Mo,6- 5L ,VRA55)NP(D, ;Btwn,) ,a';'/ " . 6 - 3S' Mcs6friVc fr, 55f 5? U?' N) wi F- Sap. n =l Lis, D 30 :1 i 8 - )4 mo//110 R Si..P5? il e vil C -pss p. zh rims, �3 GU t34--5-4f 14156Kq`ll Pi 5� 7? L I. Ow/ l.- .dap, -/t Cll+f. ' DEScRlPTIOM sang SYSTEM REPAIR rYStEY OTHER FACTORS(.1946): mialb Space OW) SITE CLASSIFICATION(.1948): - . ttan Type® • EVALUATED BY: • °THERMS ENT. ✓ • 0LTAR gearcPn! /` lier , ST r.-2e-- . U it. 0 4 O CS LA i AS 4. .2 G A (P 3 N c5 t;U a ? A N ? 6 3 DS N -2 (P 4 D Tl m •OOD -4 .CaY V 00 Ca -• A VOO OHO VOIV NCP 0 0 �I -- mV T4A ll O ID O N U'' -- 4 C.;IP CI; (1;(P N W U A A -24G (T UOCNOGUO Z •- O (fC/ -. Or.. P N m co Na co co (I A 01 O V 0 U a N V U U dm co I., p V O m* rni m 1.1 Fri/4 4.-j ni rin n-7 ni ni n-71-4 ri ni ni rim ni r m a lb CP N J aN it ti i‘-1 0 0 — co m -. 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