HomeMy WebLinkAboutEHPR-12-10-8612.TIF
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CATAWBA COUNTY HEALTH DEPARTMENT
/ Telephone (828) 465-8270 TDD (828) 465-8200 WLS # 7- 00 b - () 0 \) (1 I
Improvement Permit~ AC , Repair Perwit._ Operation Permit._ System Type_ Well Permit.. , Repljl~ement Well_
Ownerl Agent :j Q..' ~ ('~~ ~ h: 0 ,,0... \) Phone "501S - 'i ~ 15
Address 3<:t15 t1lc--....k Co.\<. Rd I I-\ic..~o.." NLd'1~od Subdivision
I Section/Block/Phase LotH
- L. 1"''-0\ ^h Hv.- et" R~ ~v;)\e... rzJ
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L,'fH....1 ('\ t6"-
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Facility- HouseV Mobile Home_ Business_Multi-family_ Other Pin Number
Other Zoning Approval #
# Bedrooms # Seats # Employees Application Rate j 3.$
Hot Tub or Spa yes no Special Fixtures Basemen@no 100% Repair Are~no
Basement Plumbing Ino Water Supply' Private Well /Public_ Semi-Public_
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Type of System: Trench ~ Bed_Pump ~ Pump/Panel_ Panel_ LPP_ Other
GPD Flow
4~o
Septic Tank Size Pump Tank Size Nitrification Field: Total Square Feet Depth of Stone
Bed Size Trench Width Total Length of All Trenches Number of Trenches
Trench Length _I _I _I _1_1_ Feet on Center Maximum Trench Depth ;) 4 II Distance of Nearest Well /00 {
*DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION*
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Topo % Slope I "* 5<!..ph'(.. 5)'.s+~""" (V\-.J.)t &~ fV\ 1'\,
Texture I, I P
Structure I I () 0' F r,J ""' 0. r'\ Y vvQ. t I I 0 r-o "'" p r... p>-r ty
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Clay Min. I f' + I '\
Soil Wetness IS t"'('t>>""- lA"".('l!i... ~ Llf\W, <l b~ 11\,St<::\kd
Soil Depth () '" c:.... ^ \-0 -J" ~ k' 'l.<LD ~ y-' t L fV'\ u b\A ' \ 10 "
Restric Hoz at r I
~r r <\,c:.<L
Available space yes/no
Overall Class S PS U
Comments.
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Riser required when I c..of\"'~(\+'.:ll'\..\ 3</XI15/ c. II' .s'vJI-~"" 1
tank is more than 6 I '" '" V'" ,,"\"I. , "'t... \ -; I J
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**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME STEM
WILL FUNCTION** t: I ood P I... I ("\ W --V
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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 protection from known possible sources of contamination. No volume of
::::':;"':'" at -i:] ~;~ iY;t Hoatth D'_orent. EHS ~ e_J
Owner/Agent~, i~t'Le~ _ Septic Tank I s lied ByT Date
EHS Well Installed By Well Grout Approval Date Well Head
Approval Date Date Sample Collected
Date of Results Results
While" Office
Yellow Owner/Agent
EHS
Pink - Building Inspection Authorization '0 Construct
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DMSION OF ENVIRONMENTAL HEALTH
ON-SITE W ASTEW ATER SECTION
Sheet _ of_
PROPERTY ID #.
COUNTY
SOIL/SITE EVALUATION L,....-t..-,J ~oo b - OODd/
OWNER. 3" Q..-r:.r:-~1 Rh..,,[y ON-SITE "V~~I~~~J~~ESYSTEM l (S 10(,
ADDRESS: DATE EVALUATED. 1../, 0, "
PROPOSED FACILITY 4 () R 1-1 V\ P ~ROPOSED PESWN FLOW (1949): '16\) PROPERTY SIZE. --Lt. 5' J
LOCATION OF SITE. , -J, ~ 10 0 it~ c... r'-A.. \<. (\..l PROPERTY RECORDED.
WATER SUPPLY 'g/Private 0 Public 0 ~e:q, 0 Spring 0 Other
EVALUATION MElHOD. 0_ A~er Boring ~it 0 Cut
TYPE OF WASTEWATER. ~ewage 0 IndustrialProcess 0 Mixed
:::::;:::::::::::;;::::::::: ....... "':::::::::::::::::::::::::::::::;::::::::::::::.. .. -.. .. :::::...:......::.. ::... .........:: :;;...:::......:::".. :::::::::;::::::;::::::::
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DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS ( 1946):
pJ pJ SITE CLASSIFICATION ( 1948). PJ
Available Space ( 1945) J Bo,,)
System Type(s) lJll IIA EVALUATED BY
OTHER(S) PRESENT
Site LTAR 3J ,35
COMMENTS.
LANDSCAPE POSITION
~
use the
SOIL
TEXTURE
LEGEND
standard abbreviations
CONVENTIONAL LPP
.1955LTAR* .1957LTAR*
MINERALOGY!
CONSISTENCE
CC (Concave Slope)
CV (Convex Slope)
D (Drainage Way)
DS (Debris Slump)
FP (Flood Plain)
FS (Foot Slope)
H (Head Slope)
L (Linear Slope)
N (Nose Slope)
R (Ridge)
S (Shoulder Slope)
T (Terrace)
STRUCfURE
S (Sand)
LS (Loamy Sand)
1.2 - 0.8
0.6 - 0.4
NEXP (Non-expansive)
SEXP (Slightly Expansive)
EXP (Expansive)
G (Single Grain)
M (Massive)
CR (Crumb)
GR (Granular)
SBK (Subangular Blocky)
ABK (Angular Blocky)
PL (Platy)
PR (Prismatic)
II
SL (Sandy Loam)
L (Loam)
SCL (Sandy Clay Loam)
SiL (Silt Loam)
CL (Clay Loam)
SiCL (Silty Clay Loam)
Si (Silt)
0.8 - 0.6
0.4 - 0.3
ill
0.6 - 0.3
0.3 - 0.15
MOIST
~
IV
SC (Sandy Clay)
SiC (Silly Clay)
C (Clay)
o (Organic)
0.4 - 0.1
0.2 - 0.05
VFR (Very Friable)
FR (Friable)
Fl (Finn)
VFI (Very Finn v. Very Sticky)
EFI (Extremely Finn)
NS (Noo-loticky)
SS (Slightly Sticky)
S (Sticky)
VS (Very Sticky)
NP (Non-pl....1ic)
SP (Slightly Plastic)
P (Plastic)
VP (Very Plastic)
None
NOTES
HORii'oN DEPTH In inches below natural soil surface
DEPTH OF FILL In inches ftom land surface
RESTRICTIVE HORIZON Thickness and depth ftom land surface
SAPROLITE S(suilable) or U(unsuitable)
SOIL WETNESS Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less _ record Munsell color chip designation
CLASSIFICATION S (Suitable), PS (Provisionally Suitable), orU (Unsuitable)
Evaluation of saprolite shall be by pits.
Long-term Acceptance Rate (LTAR): gaIJday/ft2
Show Ilrofile locations and other site features (dimensions, reference or benchmark, and North).
* Adjust LTAR due to depth, consistence, structure, soil wetness. landscape, position, wastewater flow and quality
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