HomeMy WebLinkAboutRBPR-03-2017-25984.TIF
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Owner/Agent
, Address
CATAWBA COUNTY HEALTH DEPARTMENT
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6841
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,Other: Tax Map or Pin Number l/t:;:J..~ (jl I? I/b I?t;;
, Zoning Approval #
(,t # Seats # Employees , Application Rate ~ GPD Flow <jRt)
Hot Tub or Spa yes@pecial Fixtures Basemen@o ,100% Repair Are eo,
Basement Plumbinl@no ' Water Supply: Private Well_ Public .....-$emi-Pubhc_
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Type of System: Trench ~ Bed--==-- Pump ~ Pump/Panel~ Panel-=- LPP ----=== Other;ZS '6 y<j:':f) &.I Op ()/I/ S r ('.
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 - /- / - / - / - / _ Feet on Center - Maximum Trench Depth -- Distance of Nearest Well
*DO NOT INSTALL SEPTIC WHEN ET* *WELL RECORD REQUIRED AT COMPLETION*
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Filter ReqUired'S1' I
Riser required 'W~'_I,
tank is more than &'1 '-,
inches deep. I~
**NO GUARANTEE OR WA'RRANTY
WILL FUNCTION**
Topo.s:> % Slope
Texture CL;q-y,ry
Structure $tf!J..t3
Clay Min. / ;/
Soil Wetness
Soil Depth .v.2.. " I
Restric, Hoz, a~ I
A vailable space e 0 I
Overall Class ~
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IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TI E THIS SYSTEM
*Improvement Permit has no expiratio date and is transferable, but may be revoked if site plans or intended use changes for the proposed
facility. An Authorization to Construct is aIid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years
provided site conditions do not change. W~ocation, installation, and protection must meet state and local regulations, and must be
inspected and approved by a representative oflhe 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
water is guaranteed at any site by the Health Department.. ,~.
Permit Date OV, EHS G, :::::/./I~, /2, <;',
Owner/~ Septic Tank Installed By Date
EHS V Well Installed By Well Grout Approval Date
Well Head Approval Da e Date Sample Collected
Date of Results Results
White - Office Blue - Building Inspection Operation Permit
EHS
Green - Building Inspection Authorization to Construct
Yellow - Owner/Agent