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HomeMy WebLinkAboutRBPR-03-2016-23371.TIF 43/4(% BA G THIS IS NOT A PERMIT Case # RBPR-03-2016-23371 San a CATAWBA COUNTY HEALTH DEPARTMENT O - MOb O r PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES s+ J842 SM Residential Building Plan Review - Manufactured Home o • o d l � IMPROVEMENT Q A C) 97% Applicant OAKWOOD HOMES#712 (ELIOBERTO ALFONSO), 1265 70 HWY W, NEWTON NC 28658 B:(828)217-1862 C:(828)464-2662F:828-464-4301 R7I2 @CLAYTONHOMES.COM Owner HAROLD HELMS,2523 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 H:8284783620 HOME:8284783620 Parcel Owner JENNY HELMS,2523 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 NAME TO APPEAR ON PERMIT Harold Helms SITE ADDRESS: 2523 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 PIN # 369802871680 NAME of SUBDIVISION: Lot# 1 Section/Block PROPERTY SIZE: Square Feet Acres 1.36 DIRECTIONS: Right on Hopewell Ch Rd-pass church through curve-go approx 1/2 mile-lot on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY• 360 WATER SUPPLY: Private Well DESCRIBE WOR : New 3 6i room Doublewide 28x56, Decks: front 6x6, back 4x4. *2 permits found for this lot. Owners names from deeds &driving directions match. l reflects 2 BdRms &the other reflects 3 BdRms. Need to determine correct septic sizing & if an AC will be required. SITE INFORMATIO' Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES",then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF mobile home, pool & several bldgs EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: Mobile home 72x14 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 28 x 56, Decks: F 6 x 6& B 4 x4 Desired system pes(ImprovemenrPermlttrAuthorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplication 03/15/2016 13:41 Page 1 of 4 v�$•• CATAWBA COUNTY Case# RBPR-03-2016-23371 I"ta,,y Public Health Department Subdivision 4 ; �y 4 Environmental Health Division PIN# 369802871680 f� PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 1842 ,M NAME ON PERMIT: ( HAROLD HELMS), 2523 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 ( Harold Helms) Site Address: 2523 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 1.36 Directions: Right on Hopewell Ch Rd-pass church through curve-go approx 1/2 mile-lot on right Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working days of application date. If you need further infonnation or assistance please call 828-466-7291 AREA1 FEENAME' =' .-C2'.kitlan c w yy' 'XSbI f ,arc�L rv;' .�t�niF I... 4 x dEtV t ,t,. 47 a DATE FFF AMOUNT Improvement Permit Fee 03/10/2016 $150.00 �' fps a .t 61U6If EES l3 t tl ii = t`H IPME :'� 9 a S150 00 fits. .ar id;>. ' .e.. ayea an- L x ,arltr a e s- a m<'^',_ flii ;?g *a r.,«� fanill t'.L°` ..a.. 92015 +-... have �«.�., J7.,.4'"x,,.µ.^ FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 03/15/2016 13:41 Page 2 of 4 • v44 A • THIS IS NOT A PERMIT Case # RBPR-03-2016-23371 CATAWBA COUNTY HEALTH DEPARTMENT El xo °°' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ti}� 1842 sm Residential Building Plan Review - Manufactured Home : G� y IMPROVEMENT ,tea o Applicant *OAK WOOD HOMES #712 (ELIOBERI'O ALFONSO), 1265 70 HWY W. NEWTON NC 28658 B:(828)217-1862 C:(828)464-2662F:828-464-4301 R712 @CLAYTONHOMES.COM Owner HAROLD HELMS, 2523 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 1-1:8284783620 HOME:8284783620 Parcel Owner JENNY HELMS, 2523 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 NAME TO APPEAR ON PERMIT Harold Helms SITE ADDRESS: 2523 HOPEWELL CHURCH RD. SHERRILLS FORD NC 28673 PIN # 369802871680 NAME of SUBDIVISION: Lot 1 Section/Block PROPERTY SIZE: Square Feet Acres 1.36 DIRECTIONS: Right on Hopewell Ch Rd-pass church through curve-go approx 1/2 mile-lot on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New 3 Bedroom Doublewide SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF mobile home, pool & several bldgs EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 72 14 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 28 x 56, 6 x 6&4 x 4 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplicalion 03/15/2016 08:53 Page 1 o14 yBw • CATAWBA COUNTY Case# RBPR-03-2016-23371 F_ " Public Health Department Subdivision < ifit Environmental Health Division PIN# 369802871680 ' ®t PO Box 389, 100-A Southwest Blvd. Newton.NC 28658 1g. 2 su NAME ON PERMIT: (HAROLD HELMS),2523 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 ( Harold Helms) Site Address: 2523 HOPEWELL CHURCH RD. SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 1.36 Directions: Right on Hopewell Ch Rd-pass church through curve-go approx 1/2 mile-lot on right Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessibl hat complete site evaluation can be performed. Date: •J[ — /5 — /‘ Signature of Applicant or Agent An Environmental Health Specialist will contact you wit ' w mg days of application date. If you need further information or assistance please call 828-466-7291 AREA1 • FEENAME ..... «., '':: .• • _ ....;, DATEW... .,,.. FEE AMOUNT Improvement Permit Fee 03/10/2016 S150.00 TOTAL FEES 5150.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 03/15/2016 08:53 Page 2 of4 -- c aPR -03-aU((a- 0331 CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT � Application for Environmental Services Page 1 Improvement Fermi Authorization to Construct❑ Septic Repair❑ Septic Malfunction ❑ Septic Expansion New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection(Pre-Approval Required) �� Application is for New Construction ❑ Existing Facility [,\ Property Address , a3 I- • ,' Ca ( r Subdivision < )h erri ( I , nrc4 I'4C �Uor73 Lot# Acres I ,ate / Section/Block/Phase Driving Directions to Property (�,�h-h D,1 /-t( '.w e c( Oh HO -72;S S C. c«C-ci — J-(h r0((<-R Curt C -Cr) Cnnroy t/a rYlt 1-c - / IJ-1- ().-) rt�� i- U G � NAME TO APPEAR ON PERMIT? 14 Owner ❑ Applicant ❑ Contractor Applicant Contact Information rr Name f.(( ,1U()c-c HThin e c ()t MPe J-tGrt `/ Address I D�< 11(-1,\L /1( ) (4)- A� ie( , '�-k * �l )C P-C 0 7c5 Phone -)c_yLpL( _ _ ( o(p LCellPhone Owner Contact Information Name --io rO( 6 (--I E■ trn 5 Address i� --- z- VGX),' L t.i eU Cam. l -C -- kerrt ( SS En vc( UC � '(0t Phone .=,�g =Lin 3 ; yQC ) I Cell Phone Contractor Contact Information Name e)(-,:v 1 F 0_3 ace (1 CGA I- Address Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant ❑ Contractor Description of Existing Structures on Site '7 y ( V di). (f kb in '€ #of Bedrooms •j- 3 Structure Dimensions - k #of Occupants .l (rte` Basement ❑ Yes (-No Basement Fixtures Yes CNo - ' i CP/(R°rzl ,-..A I `J The Applicant shall notify the local health department upon submittal of this application if any of the following arfply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. CI Yes o Does the site contain any jurisdictional wetlands? Yes o Does the site contain any existing wastewater systems? b Yeso Is any wastewater going to be generated on the site other than domestic sewage? Yes o Is the site subject to approval by any other public agency? ID Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well U Community Well U Semi-Public Well ❑ County/City/Township ater Line Is a public water supply available? •• ❑ Yes #No If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) ❑ Accepted ❑Alternative ❑Conventional ❑ Innovative ❑ Other "VCAny ▪•▪ •■ £/ L 9 LUZ-60-E0 w'd EL:SO:ZO Z LOHIN LOE17179 u 1 r CATAWBA THIS IS NOT A PERMIT - (_0 COUNTY CATAWBA COUNTY HEALTH DEPARTMENT xy, „m,,,,_, Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence New Residence El Addition to Residence #of New Bedrooms st Project Descriptio 4- tit t c �Lip `( ^ le c..) i de_ Structure Dimensions ,--) 3- K `Z n #of Occupants Basement ❑ Yes No Basement Fixtures ® Yes OrNo U Accessory Structure(s) escribe #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed U Multi-Family Residence#Units #Bedrooms per Unit*t Total# Bedrooms *t Structure Dimensions U Food Service Specify Type #Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area (Sq. Ft.) U Business Specific Type of Business Retail Floor Space #of Employees per Shift #of Shifts ❑ Other Facility Type Specify If Church#of Seats Kitchen El Yes ❑No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug El Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on-site staff. Any room that will be intended for sleeping at the time of construction or for fixture consideration should be noted as a bedroom and counted on all applications.The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the fixture. t If structure is plumbed but no bedrooms,calculated design flow is required. •• If No,a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be\peerr�f�orrm�ed..,t �([ / - Signature of Owner or Agen s l a�hl \ t �'jig S 3 — q '( w I Printed Name of Owner or Agent�E-n 1 s, f 10,1 Y laln rl �LS`� C �i c �Ly,' E/Z 9LOZ-60-E0 'w'd LE:so:?O ZILJHW lo£b17968Z8 • Catawba County Environmental Health eel (2) / / leVfrizi p•s 1 / c7+ ea ON M r c . s 40 )113-L ifFi 11 v SI t / / c-:: 4 • l' sf to 0 e l .t Parcel: 369802871680, 2523 HOPEWELL tin=50ft CHURCH RD SHERRILLS FORD, 28673 This map/report product was prepared from the Catawba County,NC Geospalial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and al damages,loss or liability,whether drtect,indirect or consequential with arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 03/09/2016 Catawba County Environmental Health O I p64 \ to (1) o \ 116 i 5 V 35\ 15 111/4111/4\r4 •\ el? 6rCt\ G \ r p2 P O h ill 4 . ' N \ le,'IliNci v\a, iso co 4. ! (10) y `3331 , ...., . 0 it, ,:, , ,... .....i Parcel: 369802871680, 2523 HOPEWELL 1in=l00ft CHURCH RD SHERRILLS FORD, 28673 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct, indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 03/09/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 369802871680 Owner: HELMS JENNY P Parcel Address: 2523 HOPEWELL CHURCH RD Owner2: City: SHERRILLS FORD, 28673 Address: 2523 HOPEWELL CHURCH RD LRK(REID): 802271 Address2: Deed Book/Page: 2432/1705 City: SHERRILLS FORD Subdivision: State/Zip: NC 28673-7736 Lots/Block: 1/ Last Sale: School Information: School District: COUNTY Plat Book/Page: 57/30 Elementary School: SHERRILLS FORD Legal: LOT 1 1 PL 57-30 PL 57-30 Middle School: MILL CREEK Calculated Acreage: 1.360 High School: BANDYS Tax Map: School Map Township: MOUNTAIN CREEK State Road #: 1850 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-40 Building(s) Value: $1,800 Zoning2: Land Value: $14,600 Zoning3: Assessed Total Value: $16,400 Zoning Overlay: WP-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710368800J Building Details 2010 Census Block: 3001 WaterShed: WS-IV Protected Area 2010 Census Tract: 011501 Voter Precinct: P31 Agricultural District: PROXIMITY Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2015, Catawb ounty Gover ment, North Carolina. All rights reserved. -.SA7N(N OTX\re. ? ?a\Ril'\ ° _2 . A 21 i-3 r Ot gym, 317dgm *Z C\S ca \fdtj./ h Onvos clre nntrfc {mVe http://gis.catawbacountync.gov/nornap/parcel_report. hp?key=369802871680&typ=P 3/10/2016 v N° 3425 C A T A W B A COUNTY H F,A L.T H D E P A R T M E N T (704) 465-8270 lot Eval. Improve. Permit Repair Permit Cert. of Comp. Permit Oper.� Permit Owner/Agent Phone g 1 Address U Subdivision Section/Block •tfk < _Lot Size ��i . Directions: 5 ?i!V'' :_ / !.,/ - £_ , . - SC , • ..s, aPt - ay. rhieso.t 4L4 ;I t-A l b+ 64w AY-4 $/tw /16,444e. Facility: House Mobile Home X Business . Other: Zoning Approval)no it /4t1?SL Multi-family_ Other . 100% Repair Area ma4 no Bedrooms Seats Employees . GPD Flow 360 Application Rate C,' Hot Tub or Spa yes,)Special Fixtures . REPAIR NOTICE: REPAIRS MUST BE WITHIN Basement yes4 Basement Plumbing yeses . 30 DAYS OR DAYS FROM DATE OF Water Supply: Private X Public . PERMIT. Type of System: Trench )( Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank boePer Pump Tank i Nitrification Field: Total Square Feet Depth of Stone Bed Size Trench Width 3 Total Length of All Trenches 3L ' Number of Trenches' Individual Trench Length /006571649i / Feet on Center Maximum Trench Depth Length /006571649i Length /006571649i Distance of Nearest Well Lot Evaluation: Approved yes/no (Void After 24 months) s Topo b % Slope Sketch of lot Evaluation Site - System Design - Texture cleue / I Structure a — Low Plea, - 1 ) Clay ?fin. f% f -- _ ) Soil Wetness , _ Soil Depth f /f`f 441/a_ ?p.,)„-, /�P� Restric. Hoz. at " / �`�"'� _ / Available space *jam no I Overall Class S`, , I `_IR A a Comments: f 1 5=:1 PrelllectAff 464-4- I 1 �I 31 �"'�ir� ° a 1 I A. 1 r1D�Ie I I 1 .1.-.1--,..0 I tlt, 1 1 I -.. 1 1 c'1 I 1 1 I I **NO GUARANTEE OR WARRAIITY IS i IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS I PERMIT** Permit Date g dQl (Improvement P i ,void er 60 months) ! / SI Sanitarian LG.- r"h- 0:•mPr/Agen _ r`•i: �L •)rr�— Installed By '' i 4/97Y Date $=/?-9/ Sanitaria (Note any chanops/infcrmarinn in rPd nr by skPtrh on hark WY,ite-Office Blue-Bldg. Insp. Comp.' Yellow-Owner/Agent Green-Bldg. Insp.I.P. , ■ \ Q. L pi C A T A W B A COUNTY HEALTH DEPARTMENT - (704) -46'3-8270 Lot Evaluation /Improvement Permit c - Repair Permit Completion Perrnit__ - Owner/Agent jacciUM Ebb/ART-25 Phone No ' 2310 Address gs2 . SN CP,Pit < re"e.M_,ZED Subdivision S/ PpJiCS . .QQ,-/IA C --_—_ Section/Block Lott/ Lot Size_tQS.�//,t0?G$ Directions:_-__di/jf..._ !Y "ceezcz,S—. A2d.__�aD_-_...._&s —. OJV_735- .JA2 CcJC LL G/4_,__R.D- ...£ekcc G LYG ze 4G1L.GUJQ.IJS- d_ ,de______ v..2. _fnic._.___-40T._-a&__.ei /_= — ..._.... --Facility: House __ Mobile Home_, BU-siness____ . Other: Zoning Approva WWI no U /38-Z3 Multi-family Other_ . 100X Repair Area yes/no ,/ Bedrooms . Seats Employees_ . CPO Flow 34 Application Rate . 9/ Hot Tub or Spa yes d•pecial Fixtures . REPAIR NOTICE: REPAIRS MUST BE WITHIN Basement yes/ Basement Plumbing yes' . 30 DAYS OR DAYS FROM DATE OF Water Supply: Private L,.....--Public . PERMIT. ************************-****************************************************************** Type of System: Trench t— Bed System Other (Specify) Tank Size: Septic Tank ._ /0 b 0 L— Pump Tank Nitrification Field: Total Square Feet 6O Depth of Stone 101_-- Bed Size Trench Width 3 / Total Length of All Trenches c:9450----- Number of Trenches Individual Trench Length M /_ / Feet. on Center__ 7._ Maximum Trench Depth_-' Distance of Nearest Well -__S-6-t- Lot Evaluation: Approve.rp o (Void After 24 months) ************************************************************** *************************** Topo S % Slope I Sketch of lot Evaluation Site - System Design Texture- TS' CC't9 I I ® 14j«(r Structure f0,.... !r I L,--- _ 1 V' aAt Clay Min. /; / I Soil Wetness " 9 Soil Depth_ 3'- " I Restric. Hoz. at9' " Available space /nol Overall Class I Comments: I if/, � / \ ov ,-aT 6a_ \\ FRo in- I � _. 1 ' X3 / • I 1 ****************************************************************************************** Permit Date_ jt, . Jr /r (Improvement Permit v•id after 60 months) Owner/Agent _!/ i ' ' Sanitarian _ r Installed By iY/f � - Date 9-/0-70 Sanitarian _ (Note any changes/information in red or by sketcr on back) i WRITE.OFFICE COPY YELLOW-OWNER/AGENT COPY