HomeMy WebLinkAboutEHPR-01-2018-28184.tif
11>\ . X AC
Owner/Agent
Address
Facility: HouseL Mobile Home_ Business_Multi-family_
Other
/I Bedrooms ~ /I Seats /I Employees
Hot Tub or Spa ye@Special Fixtures
GPD Flow 'Ja>O
Semi-Public
Type 'of System: Trench~ Bed-==- Pump==== Pump/PanelX Panel~ LPP -=====- Other ~
Septic Tank Size C Pump Tank Size Nitrification Field: Total Square Feet Depth of Stone
Trench Length =-/=-/ -=..../ -=/ --+ _ Feet on Center Maximum Trench Depth Distance of Nearest Well
*DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION*
************************************t!'1~~~*******************************************************************************
. C '-5 Co I./r.;,- D
Topo % Slope I \.- '?I Uc
Texture I
Structure
Clay Min.
Soil Wetness
Soil Depth
Restrie. Hoz. at
Available space yes/no
Overall Class S PS V
Comments:
I
I
I
I
5l::f:-StJ/G. /Vo7t;3 I
I
I< . W/'-'L-I/9/'fl.? I
lVDe77f O/cV II~~Q.
I
I
I
I
I
I
I
I
I
I
I
I
inches deep. I
**NO GUARANTEE OR W ARR
WILL FUNCTION**
r - - - - ---
I ftll...DP{)S\7:!:)
p.pp . I
___ 0f () .-
./ 1;" I
o ~ -'
-~
NTY IS I~EN AS TO HE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
/
**************************** ********~~* * ~*********** **~********************************************************
*Improvement Permit'hllS"noexplratJon date a IS tra sera e, but maj1>e rev~ed if site plans or intended use changes for the proposed
facility. An Authorization to Construct is vaH for (5) Ii years from date issued anlNs not transferable. Well Permit vaHd 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 by the Health Department. r-' ~ '
Permit Date . o:::L EHS (...2::- ~ 0.=-/ J? ..s ,
Owner~l Septic Tank Installed By
EHS Well Installed By
Well Head A roval Date Date Sample Collected
Date of Results Results
White - Office
Bed Size
Filter Required
Riser required when
tank is more than 6
Trench Width
Total Length of All Trenches
Number of Trenches
--PlUS
~
"
~
'"
c
-~
g
vJ
~.
'-l
'-J
Date
Well Grout Approval Date
EHS
Yellow - Owner/Agent
Pink - Building Inspection Authorization to Construct