HomeMy WebLinkAboutEHPR-10-2017-27554.tif
CATAWBA COUNTY HEALTH DEPARTMENT (lO>J1d
Telephone (828) 465-8270 TDD (828) 465-8200 WLS# ()t)05'-oO'it:>4
Improvement Permit~~P( AC epair Pepnit. Operlltion permit._ System Type~ Well Permit.__ RePlacem. ent Well---,--
Owner/Agent I. D1Y1 ~ c:L Phone. .
Address Subdivision
SectionJB ock/Phase "
L C-edQ4
-.;:-::~~~.;.(
Lot Size ,,1..
Directions
Ie>
/5D
Property Address .3 IJ~ ,-e(i~.y-woo d .. / y
Facility- House~ Mobile Home_ Business_Multi-family_ Other' Pin Number LJ~/1-tJLf--7..:S- '"1/7'7
Other . Zoning Approval #
# Bedrooms l-f # Seats # Employees Application Rate . (') 55 GPD Flow L/.f( 0
Hot Tub or Spa yes/no Special Fixtures . Basement~/no. 100% Repair Are~@'no . .
Basement Plumbing (JPIno Water Supt>>Y: Pnvate Well~ Publ1c~ Seml-Publ1c~
*************************************************************t><:********************************************************
Type of System: Trench ~ Bed~ Pump ~ Pump/Panel Panel~ LPP ~ Other .'.
Septic Tank Size /;()'O"Ol~1 Pump Tank Size IO{){)tfV( Nitrification Field. Total Square Feet fR Y& Depth of Stone V/;!l
Bed Size Trench Width 3 ~ Total Length of All Trenches ;;;. 3() Number of Trenches
Trench Length _/ _/ _/ _/ _/ _ Feet on Center .C; Maximum Trench Depth 60 Distance of Nearest Well $ () +
*DO NOT INSTALL SEPTIC WHEN WET* *UlELL RG:C'{lF. Q~U.~ AT COMPLETION*
************************************************************************ ******************** *** ~~7********************
%~~ 3~
Topo
Texture
Structure
Clay Min.
Soil Wetness
Soil Depth
Restric Hoz. at
A vailable space yes/no
Overall Class S PS U
Comments.
-type '-1 ~epm sy~~
reitutUs Ce-ft I~ d
.~ I
o pa-yfY~ i
_/~ ~t JJ-.
J ,I
~ RC1'A s r d-t'
" I
L"u-( - I
I
J l) () tv~(l<f '~IJe
I~
inches deep. I
**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
WILL FUNCTION**
************************************************************************************************************************
v., 4,y
f
I t; 1- -s:>
o
(00 i- to
E:-tS"-3>
{pl"Vc(
;)D'
q L. fro+-
pYO (f31hy
I
q~
Filter Required
Riser required when
tank is more than 6
n ,e lllie ' 0 osei,l
n 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 kn ossible sources of contamination. No volume of
water. is guaran~ te d at any. site by the Health Depart.m ent.
permit Date ~ EHS ," "
...><;pwner/Agent ".ft5t-------.. Septic Tank Insta.l d By Date
EHS Well Installed By Well Grout Approval Date Well Head
Approval Date Date Sample Collected
Date of Results Results EHS
White - Office
Yellow - Owner/Agent
Pink - Building Inspection Authorization to Construct
Jr-"';"
."
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL HEALTH
ON-SITE W ASTEW AJER SECTION
~r ~,
Sheet I of I
PROPERTY ill #. zg:.2iJl6'7
COUNTY ('11=7
SOIL/SITE EVALUATION
lfor ON-SITE \;V ASTEW A TER SYSTEM
OWNER. I;t. APPLICi}TIPN,lIA. TE. .
ADDRESS: ~ 6:, '/ n)' 4:>AA.. Vr
PROPOSED FACILITY / PROPOSED DESIGN FL W ( 1949):
~OCATION OF SITE, . -3971 .
WAtERSUPPLY.~ Private 0 Public 0 Well 0 Spring 0 Other
EVALUATIONMElliOD" 0 AugerBoring A Pit 0 Cilt
TYPE OF WASTEWATER. j~~ewage 0 IndustrialProcess 0 Mixed
(j'-OJ3-0
DATE EVALUATED' Cj-/Z-5'-
PROPERTY SIZE, <V C/f?
PROPERTY RECORDED'
..........................,.
.......... ............ .... o.
J!:i:: Hi2iHYHHUi
i'iL:::::i::ii:iiiiiiii::i:iii:::
i:O=iii:iii::iiiii::iii:i"ii:i"ii
'iF:ii: Hi!!!:!!!!!!!!/i!!!'!!!!
,~" 1!!II't.!II!!11
:iCi U}osl'iio&h
!!!:sLoi>Eiio/ci/
............................
........-.....-.............
X
1 370
...,.,.. .:::ii:ii":::ii::i"ii"i:iiiiii""ii:i:::iiii::iii:ii:i:ii"i::=ii"i:i" :"i=::i:iii:"=i::i:ii:i:iiiiiiii:ii::::ii::::,,i:::::i::::::::ii< ii"iiiii"i:"iiii::ii=i
.......- ::::::::::::::::::::::::::::::::::::::::::::::::::::;::::::::::::::::::::::::: .:::::::::::::::::;::::::::::::::::::::::::::::::::::::::::::::::::::: ::.... ....... ...... .::::::::::::::::':i::::.
~@i,ffil'~~llmffi@~M!IIIIIIIIIII!I'Illllll!llm 11'~~II'~~~~~~III!!IIIIIII,!!111 ,"'," , """"" ,IIII!,!!IIII!,IIIIIIIII:
~iilll !~~I~i~11 !1!I!B~~~~~m 1!!f~ii~~;II!~~i"JII !I!!R~il!11 :11~~llillll!II!I!
Il?---- 6 ell I CI.- /-R I 5e;o~
1~~4'V 5l31~/ (L h / _~fdL
I I 'r
I
4#
Iry
~~-I
.1
I
,
r
I
L.-
2 370
~ :Vl /1 /J
SIr! IVI
v
3~
/' /1 Jf
/) m V~ r
l./ '
I
I
I
I
l-
I
I
4
DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS ( 1946):
Available Space ( 1945) ,.s -.5 SITE CLASSIFICATION ( 1948)' ;P.5
System Type(s) 1>1>136 ??8125 EVALUATED BY Q,,e?
OTHER(S) PRESENT
Site LTAR r35 r 3 ""
COMMENTS:
=
.'
,..--."\;.
\
\
LEGEND
LANDSCAPE POSITION
~
use the
SOIL
TEXTURE
standard abbreviations
.'
\
t
CC (Concave Slope)
CV (Convex Slope)
D (Drainage Way)
,.:.. 'E.>S,(Qe~SIUWp)
'I;P(flood P~)
FS (Foot ~Iope)
If (Head Slope)
'L(Linear'Slope)
N (Nose Slope)-
R (Ridge)
S (ShoulderSlope)
~ (Terrace)
CONVENTIONAL
"- .1955LTAR* ,
LPP
,1957 LTAR*
j
0.6 - 0.4
MINERALOGYI
CONSISTENCE
,STRUCTURE
...
.f.;
SJSand)
LS (Loamy Sand)
i
1.2 - 0.8
c I
SL{SandYtLOmil) ,,-,_ .I,... '
L (Lo'!A1f'l: w
Sl::E(Sandy Clay L6am):-
'SiL (Silt Loam) .. ,t, ,
CL (Clay Loam)
SiCL (SiltY Clay Loam)
Si (Si!t) I, <
,
6~8 . O~~ ~..' ~i
,
,0.4 -oj.
NEXP (Non-expansive)
SExP,(S~ghtlYE~ansive)
EX!.' (Expansive),
G (Single Gciin) .....(
M (Massiv"c) ~ (i
CR(Crumb) ,
GR (Granular)' , .
~BK(Sub.ti1gwar Blocky)
" ASK (Angular Blocky)~
,. 'PL (PlatY) ""
PR(Prilmatic) 1 !
,II
,
'"
("' -
,\C ' ~fn.
\"
0.6 - 0.3
.
0,3 - o.is
,~
, '
-f"-'
,,' 'i-
~',.,
('
tl
MOIST-
IV
SC ($,l!"dyClay)
SiC (Silty Cllly)
qClay), I.
o (Organic),' '
oA - 0.1
0,2 - 'o;os
vFR (VeiyFriable)
FR (Friable)
FI (Finn)
VFI (Very. Firm v. Ve.-ySticky)
im(ExtreineIyFi!"'),
NS (NOQ-,st!~y)
SS (Sligh~Y:Sticky>.
S (StickY)::.l' 'j..,
VS(V~.ySticky)
! NP(Noi1-plasticf'
t ~p (Sli~t1y:.Plastic)
, , P (Plastic),,;
VP <v,eryPI""tic). 'S i ~
: ,
l:-
j,
,
"
'None
, \,' * Adjust LTAR due to ~ep~~:cons!stenc~'sthJcti.re, soil wetl1~ss, landSCi1Pe"P'~SitiOD; wa.ste~ater how'amtquality
NOTES'". ' .:
HORIZON DEPTH" In inches below natural soil Surface .,
,"JJEPTH9FFlILIn inche~ frOm land siJIf"aee' . I ';
RESTRlCTIVEHORlZON J 'Thi~Imess aria depthfiomland'smface
SAPiwLiTk . 1. . S(sUi.table) orU(urisuitable) '. ! \ . ' -"'. . '. . . I ..'
selL wiTNESS Inches from land surface to free water or inches from'l~d sUifaa: to'~oi1,~lors with chfoma 2'orless _ recotd'MiinieU color, chip designation
CLASSIF1..GATION , S (Suitable), PS (Provisionally Suitable), orU (Unsmta1:l1e)
Evaluation of saProlite shaU be by pits, I . , " .::
L~ng-t~ AccePtance Rate (LTAR): gal/day/if' ,
; ; Show rome locations and other site features (dimensions, reference,or.benchmark; and North).
!"i. \,
"
, ,
' ,
",:r;~:'I]'J;::IJ;~;';'II";'I:';~+I;:'!J
i 1 .': \":
;.
\
I.,
{~
............:-......
~,
: i
DENR,(######)
Revi~ (#####)
...::
'.
.
J- .....
<~
......" ~"'~..
\.
,.I
:t-...
":.....
i ,
l,j
l_