HomeMy WebLinkAboutEHPR-03-2018-28553.TIF
~ CATAWBA COUNTY fIEALTH DEPARTMENT N~. 706M
Tol'ph,u" (1!28) 465.8270~ (828) 46'1ljl/O ~
Au . to C t. R~ . Prmt. )( Opr. Prmt. Sys. Type ~ Well Prmt;~ Well Rpr. frmtr
13, Jk. Phone ~ 471JtL
()" (,-' Subdivision
Vl C Section/Block/Phase; _ Lot#
(/Jirections: 10 W ... -(41 J 0 ltI (t'Jltt'\/c.(,r ~ tw #zt LlJl.I1 ('2..('1
Facility: House Mobile Home_Business _Multi-family _ . Other: Tax Map or Pin Number'
Other . Zoning Approval #
# Bedrooms # Employees . Application Rate 4 GPD Flow :--<6 ()
Hot Tub or Spa ye Basement ye~. 100% Repair Areado
Basement Plumbing ~ Water Supply: P~ WeIlL Public_ Semi-Public_
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Type of System: Trench_Bed l Pump _ Pump/Panel_ Panel_ LPP _ Other
Septic Tank Siz~y I~ H ru/ Pump Tank Size Nitrification Field: Total Square Feet 9 {J7) Depth of Stone /9 II
Bed SizeS' t2<;~nch Width Total Length of All Trenches Number of Trenches
Trench Length _1_1_1_1_1_ Feet on Center Maximum rench Depth "'gIll (I Distance of Nearest Well So fl
*DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION*
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Texture ~" I lA.' t1 . t;r-t.- \, , ~r
Structure S iLl ~./ y"\ e \f\ () eaJ rvt
Clay Min. - U-- I , ~} d 'Wit
Soil Wetness - "I .. r ntl Itll I -
SoilDepth~" I Ir d .
Restric. Hoz. a~t -" I d~
A vailable space 0 I all\.
Overall Class I
Comments: I
R \ \ I
~(l,. I
1_ _I
~ tv 25- 'h~P '0)( c..tC
I
1/ L__ '" I
l V ~l17~ I ~)\pIJ
lO i 4,r
> I l~ If <;,f,nu
I
I
I
I
I
I
inches deep. I
**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
WILL FUNCTION**
Lot Size
-W
~
Filter Required
Riser required when
tank is more than 6
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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
wate~ is guarant ~,d n "te by the Health Department. ~
Pernut Date " EHS ~ ~
Own A t Septic Tank Ins y . I'MAI1 " Date n ~& "49
EHS Well Instclled By Wel rout Approval Date
Well.H CI pro al Date Sample Collected .
Date of Results Results EHS
White - Office Blue - Building Inspection Operation Permit Yellow - Owner/Agent Green - Building Inspec~ion Authorization to Construct