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EHPR-6-11-11512 (2).TIF
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DMSION~OF ENVIRONMENTAL HEALTH ON-SITE WASTEWATER SECTION Sheet _ of PROPERTY ID #: COUNTY: SOIL/SITE EVALUATION I.vL-S 2~v) _ ,, ~ 3 4~';3 OwxER. ~ ~ ~ ~ o C ON- yT*T! E ~YVASTEWATER SYSTEM .~.- ~ °' A_rPLICATION DATE ADDRESS: PROPOSED FACILITY; `~ FI-- • PROPOSED DESIGN FLOW .1949): S b ~ DATE EVALUATED: ~ L LOCATION OF SITE: ' 1 S.S ~ c ~ t, :..~ je ~ ( PROPERTY SIZE: , ? 7 WATER SUPPI-Y: ~ Private 0 Public PROPERTY RECORDED: ~ Well Spring ~ Other EVALUATION METTiOD: ~ Auger Boring Q Pit ~ Cut T'YPE.OF WASTEWATER: ~ Sewage ~ Industrial Process l~xed ................................................... ... ... . ::PEEEE E:::EE:c:cEcEc:icic:::::::: EEEEEEEEEEEiE:::::::::EEEEEEEEEEEEE~(:EEEEEEEiEEE::EEEEEEEEEEE:EEEEEEEEEEEEEEEEEEEEEEEEEEEESEcE::::::: ::::::::::::::::::::::::::::::::::::......................................... .......................... . E:1tE:E :::::::::::::::::::::::::::.E EEEEE:EEEEEEEEE. EEEESE ~~iEisiiEEEEEEEEEEEEEEEEEEEEEEEEEEEE'EcEci:?EEEEEEEEEEEEEEEESEEEEEEEEEE EEEEEEEEEEEEEE:EEEEESEEEEEEEEEEEEEEEEEEEEEEEEEEE~EEEEEEEi ESEE:::c EE::::E:iEE::E:::E:t:2cE:E EEEEEEEEEEEEEEEEiEiii' ~' E~Eei~EE~:'EEEc:`~ E:'iE`''€`rE`.':'• E:........EE ......:..::..:....E:::..EE:..:::::•:E::E~E:::E'• ~EEiEE EEE=EEEESEEEEEEE~E`:~EEEEEcE:'~iii~'E''iEEE~Ei~EiEEE~'E~. EEE ;EE ......:::::::::.....::....... EEEEEEEEEEEESEEEEEEE• ::::::::::...........:::::.........:.. ,.........................................:::::....::::::OTHE ~::::::.....................................................................::::.,.EEEEEEEEEEEEEEEEE. :::~ ::::.....................:::::::::..................::::::::::::::::.:............:.•:•:•::•:•::•::::::...........................::::::::::::::::::::.....R...........:::::::::.:::::::::::::...................:::::::::::::.,.............:. ~::::::::::::::::• ......................:..~:FA~~'~:::::::::::::::::::::::::::::::::::EEEEEEE:::::::::::::E:::::::'s: :::~ :::::::::::::::1~4Q::::::::::::::::::::::::::t::.:......................:::::::::::::..................,.....:...,:..;.........................................,............................................. ::~ :::...:...................:::::::............ ......:..::::•:~:.:.........:::E:::-::::::::::::::::::::: ....... ::. :::: ::::::: .. . .. :.::::::::::: il::::::::::::::::::::::::::::::::::::::::......... ...:::::::::::::::::::::::::::::..................:::::.. ~.. ~...::::::::: :............:::::::::: :::::::::::::::::. .....' ....:::::::::::::::::.. ::::::::::::::::::::::::: .......:::::::•:•::•:• •:•: •: •:::.,.................::... Y4~:E:::: ~:::::::::...;......::::::::::::::::::::::::::::.:::::::::::::::::::::::::::::::::::::::::::::::: ::::.....::::::~ ..: , . ~EEEEEEE EEEEE: :::::• ::::::::: ~ :....::.: ::::::::::::::::::::::::........:.:..• .:...:.:::::::::::::::...... . . ....::::::.........................::...............................:::::................................EEEEE~:::::~T~d1E::::::::::::::::::::EEEtES(3tt.:::..........:.f94~EE:::E EEEEaE::.. . . :: ~EEEE EEk~3S ~ ~ ' ::~ EEDE ~ .. ........STR :.... .. ..... .......... ::::•:: E~EEE:-~956€€'€• ~s~9'44€s::;s;~: ...............~;Ii3N1.:::::::.... P~'f€:::::::::::::::::::IICT~1Ft~~::::':€s:':~(5NS15'i'Et~t~Bl:::::s :::?1'i' •.:::::::: •:::~::.:.. :~: ::::::P .. . . ... .....::::::~:::::.~SSlEE .:::::~OiE,::::::::::SAPR(b:'sitRS: `:"::::::::;R©FZL£ .........:::•:•::::::•::•:::::.:: •::.....:::::~ ::::::::::::::::•.::::....::::::::::::::::::::•::: ~:::•::MIIa'ERALi3GY:::::::::::::G(IL{;lR::::::::::DEP::.::::::::~ ...:• ::: ::::::~~A;SS:::E: .... .. .. ..........::....::::.:•.:::•.:•.:::::::::::~ ::•.:::::::_ E::::::::::::::::::::::::::::::::::::::::•:::::::::::::::::::::::::::::: TH::::::: • . ........................................:..::::::::::::::::::::::::::::::::::::EEE EEEEEEEE~~ ~€:'€€€€€:'':~I'3'•AIt:'•E L~1 ©- `~~`t Sc S~It 55 S~ ~~Cv ~` `f ~~ f . 3Sr' 1 ~ v~~L;o • ~S _ ~ . .. ~~ ~ 2, ~ 3 DESCRIPTION INITIAL SYSTEM REPAIlt SYSTEM OTHER FACTORS (.1946): Available Space (.1945) ~ f ~- SITE CLASSIFICATION (.1948): _ 'S' System Type(s) ~ ~ EVALUATED BY: _ J ~ ~ ~~ ~ OTZ-~R(S) PRESENT: Site LTAR : 3 5 ~ ,~ S COMMENTS: