HomeMy WebLinkAboutRBPR-05-2017-26463.TIF
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Owner/ Agent
Address
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CATAWBA COUNTY HEALTH DEPARTMENTWi0L101-00..}ol
Teleph~ (828)'465-8270 TDD: (828)465-8200 fivSW N~ . 92 tJ .
- (]Ip , prmriL/ Sys, Typ. Well Prmt, Replacement Well_Well Rpr. Prmt.
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Property Address
Facility: House Mobile Home_ Business_Multi-family_ . Other: Pin Number
Other '!"2 . Zoning Approval #
# Bedrooms ;:J # Seats # Employees , Application Rate
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: TrcnchL Bed_ Pump_ Pump/Panel_ Pane1_ LPP _ Other .~ @
Septic Tank Size 10M Pump Tank Size Nitrificatiou Field: Total Squar~ Feet ~j) epth of St ne "
Bed Size Trench Width 1.{g II Total Length of All Trenches 2ft(J .z-'~C Number of Trenches .
Trench Lengtrl/l./.J'jb_J !th_.' <f:t._/lh..:_ Feet on Center CiJ Maximum Trench Depth 1.lt II Distance of Nearest Well Ilgff
'DO NOT INSTALL SEPTIC WHEN WET' .WELL RECORD REQUIRED AT COMPLETION'
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Texture {Cl. I
Structure 11J \
Clay Min, I
Soil Wetness 'lJ. I
Soil Depth IlL 1- I
Restric. Hoz. at -II I
Available space@?Lna I
Overall Class ~U I
Comments: I
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S llt.u.l e sil
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inches deep. I
"NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS S
FUNCTION"
Filter Required
Riser required when
tank is more than 6
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GPD Flow
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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 protection from known possible sources of contamination. No volume of water is
guaranteed at any site hy the Health Department. ~ .., t'
Permit Date ilL . , EHS:"... ')
XI owner/Agent~ 'i~~(~. ~/ SepticTanklns II By UJ,~..t....~-'! Dale Y-Ifr-d/
EHS {f;, - - (, ~ Well Installed By Well Groul Approval Date
Well l:fead Approval Date Date Sample Collected
Date of Results Results
White. Office Blue ~ Building Inspection Opt:Tation Permit
EHS
.
Green. Building Inspection Aulhorization to Construct
Yellow. Ownt:rJ Agent
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