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~Date <br /> <br />Applicant," <br /> <br />Address <br /> <br />MORGAN COUNTY HEALTH DEPARTMENT <br /> <br />607 Morton Avenue <br />Martinsville, Indiana 4615 ! <br />Phone 317-342-6621 <br /> <br />SITE EVALUATION FORM <br /> <br />Health Dept. Identification No. <br /> <br />Telephone No. ~--~A~ <br /> <br />Owner of Proper~y <br />Address <br /> <br />Telephone No. <br /> <br />T~cation of Property <br /> <br />Depth to Limiting Layer. <br /> <br />Soil Profile Observation <br /> <br />Depth Color Te-~ture Structure Consist. Mottles Other <br />o- ~¥ ,E' ,~c/z ,,"~-,W_ ~-"~'. .---- <br /> <br />M~ximum trench dspth allowable / ~ I' <br />Loading rate at~ inches; , ~d--gpd/sq. ft. <br />Squ~re, feet of absorption trench ~ottc~ per bedrcc~ ~ ~ <br /> <br />Cczttt~=_-~ts: <br /> <br />Signature of evaluator/ <br /> <br />/ Dat~ <br /> <br />(Sketch on back side of this form indicates location of profile holes) · <br /> <br /> <br />