HomeMy WebLinkAboutEHPR-6-11-11456.TIF
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CATAWBA COuNTY HEALTH DEPARTMENT pO
Telephone (828) 465-8270 TDD (828) 465-8200 WLS # d- otJ5 - OtJO:Ue
Repai penpjL_ . Operation PenniL~ System Type_ Well PenniL~ Replacement Well~.
(lv0 o-ro-c ~ ll'tJ Phone
124'. 4J Subdivision
Section/Block/Phase
. ;\-1./ /.-!
Lot Size 7 ~() {.;
Property Add~ess4"~6'~ //,Jrlm~ ~ 2ed
Facility. HouseL M<;lbile Hoine~ Business~Multi-family~ Other' Pin Number3~7~-m~ '}~- . ~3'1 '
Other Zoning Approval #
# Bedrooms..J # Seats # Employees Application Rate
Hot Tub or Spa yeslno Special Fixtures Basement yeslno 100% Repair Area yeslno
Basement PIll1l\bing yeslno Water Supply' Private Well~ Public~ Semi-Public_
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GPD Flow
,Type of System: Trench~ Bed~ Pump~ Pump/Panel_ Panel~ LPP _ Other
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 _1_1 ~I ~/---,--,-I_ Feet on Center Maximum Tren<;:h Depth Distance of Nearest Well
*DO NOT INST ALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION*
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Topo
Texture'
Structure
Clay Min.
Soil Wetness
Soil Depth
Restric Hoz at
A va,ilable space yeslno
Overall Class S PS U
Comments
~
~bf
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Filter Required _~
Riser required when V ,A. 1 drf~~ /00 yr
tank is more than 6 r'1"" -:f
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**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
WILL FUNCTION**
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*ImprovementPermit 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, ins,tallation, 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 ossible sources of contamination. No volume of
water is guaranteed at any site by the Health Department.
PennitDate -$tlt.~f ~- /J n EHS "
Owner/Agen, ~ J, t::0xJA/t/IitVv'-'. , Septic Tank Install
E . ., . Well Installed By ,(\ "" 1-<..
Approval Date' . Date Sample Collected
Date of Results Results
White - Office
Well Grout Approval Date 1- t~-5'
Date
Well Head
Yellow Owner/Agent
EHS
Pink - Building Inspection Authorization to Construct