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DEPARTMENT OF HEALTH AND HUMAN SERVICES Page i Qf 1
misigat OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID#:
ON-SITE WATER PROTECTION BRANCH COUNTY!..
SOILISITE EVALUATIONfor ON-SITE WASTEWATER SYSTEM
(Complete all fields in full)OWNER:;.- e,Iop,-,1"cYlic4fa-nqc5 J1-c DATE EVALUATED:1/1,4,(9.4`{'_
ADDRESS:6455 +�rv,...64. 1...1.1 co, $ ;3.. Wt. 41.E0so
PROPOSED FACILITY: jA A, - PROPOSED DESIGN FLOW(.0400): 3 6 C• PROPERTY SIZi:O `5a�
LOCATION OF SHE:\4 3 \,4..4 ttr.,s+v..LrLi G.. ....s�, jrc 1g6e)ck PROPERTY RECORDED:
WATER SUPPLY: ❑Public IS41Single Family Well 0 Shared Well '0 Spring 0 Other WATER SUPPLY SETBACK: 544
EVALUATION METHOD: 0 Auger Baring )Pit' ❑Cut TYPE OF WASTEWATER: )Domestic :0 High Strength 0IPV
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P R ,0 SOIL MORPHOLOGY OTHER PROFILE FACTORS •
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DESCRIPTION INITIAL SYSTEM .REPAIRSYSTEM
Available Space(.0508) S 5 SITE CLASSIFICATION(.0509): 3
System'Type(s) GCS S-02- EVALUATED BY: ,cyk.•, fo5.s"—
Site LTAR r3 • _-5 OTHER(S)PRESENT.:
Maximum Trench Depth 3`5" 33.4.
Comments: . . .
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NCDHHSJDPH/EHSJOSWP Revised lanuary2024
Form SSE-24.2
Catawba County Environmental Health
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Parcel:470001274753, 1483 WASHINGTON LN 1in=50ft
CATAWBA,28609
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