HomeMy WebLinkAboutIMPV-07-2022-174970.TIF 4)EPARR'MENT OF HEALTH AND HUMAN SERVICES Sheet I of?
DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID III:
ON-SITE WATER PROTECTION BRANCH 37311-7 PROPECOUNTY:_Catawba_
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
(Complete all fields in full)
OWNER 164 re Cii o1,,,- (4*l/2.00 _ APPLICATION DATE
ADDRESS: DATE EVALUATED: 1
PROPOSED FACILITY: 4160- PROPOSED DESIGN FLOW(.1949): Step PROPERTY SIZE:
LOCATION OF SITE: 31:s'Z *4 4-- PROPERTY RECORDED:
WATER SUPPLY: 0 Private ❑Public [ Veil 0 Spring E!0ther 4+6'4- -/1 1+4
EVALUATION METHOD: 0 Au$er Boring ®'rit 0 Cut TYPE OF WASTEWATER: ❑Sewage 0 Industrial Process ❑Mixed
• • •
• SOIL MORPHOLOGY OTHER
P F�t (.1941) PROFILE FACTORS
go, •k igo
SCApE RORIZON
P44.1 `'..]HQNI; DIfPTH 1942. PROFILE
LLO'Z% (tx.)
.1941 .1941 SORT. .1943 .1956. ..1944 CLASS
,41.), t • STRUCTURE../ CONSISTENCE/ WETNESS/ SOIL SAPRQ RESTR &LIAR
a `, TEXTURE MINERALOGY COLbR DEPTH CLASS: HORIZ
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' _, .D C INITIAL11t11Qt3,;,,t. ' SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946):
I ASITE CLASSIFICATION(.1948):
Available Space(.1945) PS lr0 tS
Systrm Types) Z 6 Ls-Dr /!�L# EVALUATED BY: - - �.�
14i OTHER(S)PRESENT: y yo,.}
SiteLTAR 04 0,3,f"
' COMMENTS:
Updated February 2014
�.. .. ....._- .- - .
SOIL/SITE EVALUATION Sheet+3 of
(Contbatatlon Sheet-Complete all field In full)
DEPARTMENT OF HEALTH AND HUMAN SERVICES PROPERTY ID II:
DIVISION OF PUBLIC HEALTH 1 96�"'3 DATE OF EVALUATION: 57 z f
ENVIRONMENTAL HEALTH SECTION COUNTY:
ON-SITE WATER PROTECTION BRANCH
• • • • •
P
o SOIL MORPHOLOGY OTHER
(.1941) PROFILE FACTORS
1 .1940 -
R LANDSCAPE HORi2 .1942
POSITION! ON .1941 .1941 SOIL .1943 .19% .1944 PROFILE
6 SLOPE% STRUCTURE/ CONSISTENCE/ WETNESS! son, SAPRO RESTR CLASS
DEPTH
ON.) TEXTURE MINERALOGY . COLOR DEPTH CLASS HORIZ 6§LTAR
•
s �y-31 S6tc Sc- ✓t - :31-
/ 41 L_372 k CC- `s 7 Je-
•
•
•
•
COMMENTS:
S:
Updetod Febtuwy 2014