HomeMy WebLinkAboutCBPR-07-2017-27022.TIF` ' 6 ~
~, ~, ,'a: `s`~ N° 2 918
C A T A W B A COUNTY HEALTH D E P A R T M E N T
(704) 465-8~i70
Lot Eval.~mprove. PermitRepair Permit Cert. of Comp. Permit Oper. Permit
Owner/Agent C T - _ [' hone
Address c7 S Subdivision
i , Section/Block Lot#
Lot Size j . LSAC,QEt Directions: ~~'.~ LF~- ~T° ,j~GQUI'~S X~~'~S yn,~T0
~ ~t `= FA LCD .~~ ,(~.D ~~~ ~i9 aJ:D~ ~ 1 ~ 1-}T ~~ SHE ~@>t /CAS ~'d ~P1~
~A GN4 ~2~ l~ aN R /c tfT ~,nJ Cr Qn/~ ~
Facility: House Mobile Home Business Other: Zoning Approval es o #
Multi-family- Other cNti n~M' 100 Repair Area yes/no
Bedrooms Seats /'~Mc'JnLT~~ Flow ,~_ Application Rate~_
Hot Tub or Spa yes o pecial Fixtures REPAIR NOTICE: REPAIRS MJST BE NITFiIN
Basement yes,`io Basement Plumbing yes1~. 30 DAYS OR DAYS FROH DATE OF
Hater Supply: Private Public PER1~T.
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Type of System: Trench~~Bed Pump Pump/Panel Panel LPP Other
Tank Size: Septic Tank /.,tea r K pi~ mp Tank
~i
Nitrificati n Field: Total Square Feet Depth of Stone Bed Size
Trench Widt Total Length of All Trenches y~y Number of Trenches
Feet on Center Maximum Trench De
Individual rench Length~8~~~/~/~ ~ pth~~"
Distance of Barest Well $~ ~ ~''f' Lot Evaluation: Approved~no (Voi fter 24 months)
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Topo Slope ~ Sketch of lot Evaluation Site -System Desig - n 1
Texture ~ o ~`~"rt~LC.r{C~
structure t.ca - - ~-- - - - - ~' X 3 ~
~ ~ ~
Clay ?iin. ' ~ /VC=LJ '
Soil wetnes ~ ~ / -d~TS
Soil Depth ~.~' ~ ~A~eK~~G-
Restric. Hoz. at ~ ~ ; tALJ~- Sid'
Available sp c es no ~ ~R~A ~ i - - - - - " - i
Overall Clas U ~ ~ ~ ~
Comments: - - - wc'~ - ~ SNE~ '
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**NO GU TEE OR WARRANTY IS It1PLIED OR GIVEN THROUGH THE ISSUANCE OF I PE **
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Permit Date 5 Improvement Permit void after 60 months)
Owner/Agent c ~ Sanitarian ~ ~
Installed By ~9wDS! SiP~ Date 7-a2C-9/ Sanitarian~,_ ~~,,,,,~,.:,.m~
(Note any changes/information i;~ red or by sketch on back)
WY~ite-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp.I.P.
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CATAWBA COUNTY HEAL T
DEPARTMENT
N~
6026 '
pJfi
..'
Well Pnnt. Well Rpr. Prnll,
Phone <t~</- ~S0 2-
Subdivision
. Section/Block/Phase LotH
OJ /Z/G.<tl 'J'''~I3''';::'''''-''
f'l#.."J rr//~ /e'Yd' 41
Facility: Housf_ Mobile Home_ BUJ.ines!_Mulli-f~n;ily_ ,Other: Tax Map or Pin Number 1'1 V -41 - I
Other (')~,-j,,- BA/lhdr /Prr'vt0 'J;"'/~ ,ZoningApproval# ;3tJ9?o/tJotf
# Bedrooms # Seals / # Employees , Application Rate . '-I GPD Flow a <tlJ
Hot Tub or Spa yes/no Special Fixmres Basement yes/no ,100% Repair Area~o
Basement Plumbing yes/no Water Supply: Private Well~ Public_ Semi-Public_
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Type of System: Trench~Bed_Pump_Pump/Panel_Panel_LPP_Other ~r/L Sf r
Seplic Tank Size I~A-(Pump Tank Size Nitrification Field: Total Square Feet boo Depth of Stone I C.
Bed Size Trench Width .1 G Total Length of All Trenches ~ Number of Trenches 2-
Trench Lengthl1ilP./12>>./ _/ _/ _/ _ Feel on Cenler <1 Maximum Trench Depth 02 t( Distance of Nearest Well/CO
*00 NOT INSTALL SEPTIC WilEN WET* 'WELL RECORD REQUIRED AT COMPLETION'
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(828) 465-8270 TD , (828) 465-8200
Opr. Prml. I Sys. Type ..~r.:.
Lot Size
~f;'~1<
;-.
Directions:
krc'/Zr"'
(;,5
('C)
1ft< Ih>-Io
(~/~
Topo $--/c) % Slope
Texture {'~
Strucmre A {<
Clay Min, /; 7
Soil Wetness f'''i "
Soil Depth ~
Restric, Hoz, at
Available space:pno
Overall Class U
Comments:
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Riser required when I
tank is 1II0re than 6 I / B // I <Jl.t,A(S It l \
inehes deep, I " MhWO tJ()1...d
"NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LEi:i6TH OF TIME THIS SYSTEM
WILL FUNCTION"
R~
Filter Required
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*lmprovemcllt 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 conditioll.'i do not change. Welllocatioll, installation, and protection must meet state and local regulations, and must be
insl>ccted and approved by a representative of the Catawba County Health Depar.m.lent before any portion of the installation is put into use.
The siting of the well by the Health Department staff is to provide protcction from know.n pos . Ie sources of contamination. No volume of
water is guaranteed at any sHe by the Health Department. .
Permit Date S - 12- EHS
Owner/Agent Septic Tank Installed
EHS Well Installed By
Well Head Approval Date ~ Date Sample Collected
)ate of Results- Results
White - Office
_5_
,
".., DateT-.AI;:" 7 I'm
Well Grout Approval Date / .. I
C~99' '""" ~~
Green. Building Inspection Authorization to onstnlct
EHS
Blue. Building Inspection Operation Permit
Yellow. Owner/Agent