HomeMy WebLinkAboutEHPR-5-10-5319.TIF.. - ~ ' CATAWBA
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IP AC
Owner/Agent_
Address
Rpr. Prmt
(828) 465-8~,7(~ TDD: (828) 465-8200
W LS # d~ M' ~'G~ ~y ~
Well Rpr. Prmt.
Prmt. ~. Sys. ~'ype Well Print. Replacement Well
Subdivision
Facility: House D' `yC Mobile Home Business Multi-family .Other: Pin Number ~ ~~cJ- / '~ / cF. ~'~ ~ ~
Other .Zoning Approval # -
# Bedrooms~_ # Seats # Employees .Application Rate ~ GPD Flow
Hot Tub or Spa yes/no Special Fixtures Basement yes/no .100 % Repair Area yes/no
Basement Plumbing yes/no Water Supply: Private Well Public Semi-Public
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Type of System: Trench Bed ~ Pump Pump/Panel Panel LPP Other
Septic Tank Size Pump Tank Size Nitrification Field: Total Square Feet Depth of St e ~ cr~
Bed Size ~ ~ ~ C? Trench Width Total Length of All Trenches Number of Trenches
Trench Length _///// Feet on Center Maximum Trench Depth Distance of Nearest Well
*DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION*
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Topo % Slope
Texture
Structure
Clay Min.
Soil Wetness
Soil Depth
Restric. Hoz. at _"
Available space yes/no
Overall Class S PS U
Comments:
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Filter Required I ~
Riser required when ~ ~ ~ ~-
tank is more than 6
inches deep. ~ ~ LL --
**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PEKt~ORMANCE OR LENGTH OF TIME TH ~~SYSTEIVI
WILL FUNCTION**
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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 protec ' fro kn possible so ces of contamination. No volume of
water is guaranteed at any site by the Health Department.
Permit Date ~ EH ~v~~
caner/Agent Septic Tank Installed y ~`!" ~ ~"~~' _ Date ~A6 ~ a ~-~
~HS c- Well Installed By ~ Well Grout Approval Date
Well Head A~'proval Date Date Sample Collected
Date of Results Results EHS
White -Office Yellow -Owner/Agent fink - Bt9ilding Inspection Authorization to Construct
COUNTY HEALTH DEPARTMENT ~`~ S ~~