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MORGAN COUNTY HEALTH DEPARTMENT <br /> <br />607 Morton Avenue <br />,~Aartinsville. Indiana 46151 <br />Phone 317-342-6621 <br /> <br /> SITE EVALUATION FORM <br /> <br />Date ~h.'//(~ <br />Applicant," <br />Address <br /> <br />Health Dept. Identification No. <br /> <br />Telephone No. ~/,~ ,..~-~/~_ <br /> <br />Owner of Property <br />Address <br /> <br />Telephon~No. <br /> <br />Location of Property <br /> <br />Mapped as /~ -(~3, Position <br /> <br />Depth to Limiting Layer <br /> <br />Soil Profile Observation <br /> <br />Depth Color <br />©-Io L~ <br /> <br />77 <br /> <br />pepth to Seasonal 'High Water Table <br /> <br />Texture Structure Consist. Mottles <br />~',~ /~_ ~. <br /> <br />~'~/~~. ~'. ~ <br /> ~" <br /> <br />Maxim~ trench d~pth allowable <br /> <br />Loading rate at~Tinches; ,~-~-- qpd/sq, ft. <br /> <br />Squire, feet of absorption trench bottc~ per bedrcc~ ~ <br /> <br />Other <br /> <br />Cc~tu~_nts: <br /> <br />Signature of evalua~d~ <br /> <br />D~te <br /> <br /> :: <br />(Sketch on back side of this form indicates location of psofile holes) <br /> <br /> <br />