HomeMy WebLinkAboutEHPR-06-2015-21729.TIF
~. i !.+.I/ ~ATAwBAt:OUNTY HEA.LTH DEPARTMENT posted
)""~~ , V / Tel 'phone (1l28) 46:3J3DD (828) 4~ WLS # &oo;;l -005 3 5
IP AC Rpr. rmt Sys Type Well Prmt. 1 Replacement Well ~ll Rpr Prmt.,
Owner/Agent' ,f' Phone ~ d$' - 3,333
Address 'et'e. :e Subdivision
Section/Block/
Lot Size
Property Address
F.acilitY;iHOUSe~ Mobile Home Business., Multi-tflmily Other Pin Number . .
Oth~ [11;l.Cd Welt. ^ 'ell ~:f~ ea 1 tno.l/'f:., rf l Zoning Approval #
# Bedrooms # Seats Employees ' ' #PPl1cation Rate (9 i 3 . GPD Flow 5bl5
Hot Tub or Spa yes/no Special Fixtures . . Bas ment yes/no 100 % Repair Are~/no s"f~,!:.L / T rq ns/erit
Basement Plumbmg yes/no ~a Supply' Private Well_ Publ1c_ Semi-PUWic--'\l- - ~)~~_4..tJ~
*.**********************7** ********************* **************************************************~f***~~*~*~~~*****
IV fA c'r1111 Mi.(-'/'i ry
Type of System. Trench' Bed Pump Pump/Panel Panel LPP Other v .
Septic Tank Size "'5DO~~~size I~ Nitrification Field. Total Square Feet IZ5J Depth of Stone /d I'
Bed Size Trench Width l 3 G1f Total Length of All Trenches 5 S3 Number of Trenches '~
Trench Length 3. ~;; 9'0 S; _/_ Feet on Center 7 " Maximum Trench Depth \. 56 '-I Distance of Nearest Well /(J d r
*DO NOT INSTALL SEPTIC WHEN WET* ( ,*WELL RECORD REQUIRED AT COMPLETION*
******-*******************~****~**~**3 **ei"*?:C/*~*(;.:)* ~{**~**(f*iU*(J'B*l-J:1Y~***************
Topo 4..2. % Slope I ,q~.J /\ - S rr--_
~~:~e ~ :6~ f:~ - /7- /L hL)d S/~!.LJf)~/l
Clay Mm, I'. J I' ,- ,0 L{, -rJttG-I I L \{'C r .....(,
Soil Wetness 7'tf n I '- e
Soil Depth 4 f' n I
Restric Hoz a~' JJ I
Available spac y ,7no I
Overall.Class S SI
Comments I
I
I
1
I
GP/J
f~ =- c:(()O (fIe! X" J -SA,.f:.j-s
~ f(W (lIe! -
/h~asI (f/MW/ /,1JA.' - dO 0 ~ cf
/- ,fa 1/ ./1;;' e. emp /0 VN / eX 5 (j fJ c/.
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Filter Requked i '76r:bJ 5d S", fJo/. ' oJ
Riser, required when '1';';:'; "<""';diinbi. '
t~nk IS more than-6 I.. . . ,,';. . ~~"*"-~~'c::::"I.~ _ '':4.'hl
, - -...:),'v~ ..,'1Ii.C::!ifIN,
inches deep. . ~~~:'_~
**NO G. UARANTEE OR W A AN~Y }~,IMPLIE 9!PIVEN ApO E PE~RMAN.c;F OR LENGTH OF]~l}fJ; IJHS SY "EMir
WILL FUNCTION** IV ~ tJ S-VJ ife /J1 TV y- CeJ f1 iBMclWf WetS o.L1.LJ..,Lq I
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*Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed
facility An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years
provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be
inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use.
The siting of the well by the Health Department staff is to provide protect" from known poSsible sources of contamination. No volume of
water is guarantees! t any site by the Health Department. ..
Permit Date - - EHS
'f.:Owner/ ent'..~ ; lh Septic
EHS Well Installed By
Well ead pr val D Date Sample Collected
Date of Results
White Office
Yellow Owner/Agent
Pink