HomeMy WebLinkAboutEHPR-2-11-9268.TIF � �� 1 �� CATAWBA COUNTY Case # EHPR-2-1 l-�I268
U Subdi��ision Olde Sa��annali
�-.� � Public Healtli Department
�Q� `' Em�ironmental Health Di�•ision Seclion/BUPWLot# l�
:�` � "C PiN# 37�2-08-78-9�i2
PO Boz �89, 100A South��est Blvd. Ne��1on NC 28G>8
1 M (828)�CS-R27Q Fas (R2R)-�GS-R27G 'Inl)(R?8)�1G5-R?OU
A licant/ON ner Gerald Bro�vn
Site Address: 3�78 Sa�annah Ln., Claremont. NC
Pro m� Size: l).509 acres
Directions:
EXISTING SYSTENI INSPECTION REPORT
Site/System Diagram
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T�pe of Facilit�: Housc � Mobile Home I #Bedrooms -�
Business n Specifi�
Other � Specif�
Proposcd Additions/Accesson Struclurc: 2�3�2� dctaclied �;ar��;e
Appro��ed ❑ Not Appro�ed � Rcason proposed gar�ge over drainfield
E��idence of S��stcm Malfunction: YES ❑ NO � S��stem T}-pe/Description IIIG �'E+�M�.� $� �1(i� � RfhR �o��,rur�
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NOT FOR LOAN APPROVAL
CATAWBA COUNTY HEALTH DEPARTMENT
Telephone: (828)'465-8271.1;rDD: (828) 4~~
R~tlf\~r~ Prml. " Sys, Type~Well Prml._Well Rpr. Prml.
~ th- Phone,
Subdivision nil
Section/Blo klPhase Lot#
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fee dr;'fr;hd~
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inches deep. I
"NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTli OF TIME THIS SYSTEM
WILL FUNCTION"
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Imp..Pmu. ^
Owner/Agent
Address
Auth, to ~nsl. ~
yYI
~irections:
Topo
Texture
Structure
Clay Min, I ~ I
Soil Wetness -
Soil Depth 4-g
Restric, Hoz, at .;;.-"
Available space yes/no
Overall Class iPs U
Comments: ~
dr1
~ r:; 1~
L
,;,'
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'~'
4-v
Iti~r Required
Riser rC(luircd when
tank is more than 6
au-
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3X68'
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Results
Blue - Building Impeclion Operation Permit
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Septic Tank Install
W ell Install~d By
Date Sample Collecied '
-,zv,
"'Improvement Permit has no expiration date and is transferable, but may he revoked if site plans or intended il."ie 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
prol'ided site conditiuns du not change. \\'elllocation, installation, ancl protection must meet state aud local regulations, and must be
inspected amI approved by a representative of the Catawba COllnty Health Department before any portion of the installation is put into use.
The siting of the well by lhe Health Department slaff is to provide prol clion fr m k n possibl sources of conlaminalion, No volume of
water is guaranteed at anv site by the ealth Department.
Permit Date
Owner/A~t
EHs--..:::J ,
Well Head roval Date
Date of Resu (5
White-Office
Date
Well Grout Approval Date
EHS
Yelluw . Owner! Agent
Green - Building Inspection Authorization to Construct