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MORGAN COUNTY HEALTH DEPARTMENT <br /> <br />607 Morton Avenue <br />A4artinsville, Indiana 46151 <br />Phone 317-342-6621 <br /> <br />SITE EVALUATION FORM <br /> <br />Health Dept. Identification No. <br /> <br />Telephone No..~Z-.C~/~ <br /> <br />Ac~lress <br /> <br />Owner of Property <br />Address <br /> <br />Telephone No. <br /> <br />Location of Property <br /> <br /> / <br /> <br />Depth to Limiting Layer <br /> <br />Soil Profile Observation <br /> <br /> Depth <br /> <br /> /o-/7 <br /> /7- 3/ <br /> ~,- ~- <br /> <br />/Y"-f'"/'/ .Dept/to Seasonal 'High Water Table <br /> <br />szope ~,-~ <br /> <br />Structure Consist. Mottles <br /> <br /> ~X. ,¢ F.'. <br /> ,~-~- F,~'. F-c <br /> <br />Loading rate at Y/ inches; .~J-- gpd/sq, ft. <br />Square.feet of absorption trench k~ttc~ per bedr~3~9 <br /> <br />Other <br /> <br />Signature of evaluatc~ u <br /> <br />' Dat~ <br /> <br />(Sketch on back side of this form indicates location of profile holes) <br /> <br /> <br />