HomeMy WebLinkAboutRBPR-07-2018-29695.TIF
CATAWBA COUNTY HEALTH DEPARTMENT
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8484
Telephone: (828) 465-8270 TDD: (828) 465-8200
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Imp. Prmt. ^ Auth. to Cons!. Rpr. Prmt. Opr. Prmt. Sys. Type Well Prmt._ Well Rpr. Prmt.
Owner/Agent c..1le-:<;c~ ~0{)U~ 7/1/c Phone tf,6~7" - rn '7n..s-"
Address i.V I "-.L - '"'" Subdivision .IV/)IlTfl-UJ~-,-.J ~~(iJ,
, r5/-/-r=-A /2// -' ~ <: r-:::;t)/7J':> /L/, r. . ;;:J. rfr; 7. '7, Section/Block~ T Lot# J ;)..."1
~SiZ;;p~~::~er;:,i~=/f/;;~u~:{/~o~~ ~;,1;~ ~~I ~V;~~~ <;
/3/!..A.\[JOI{) DI€.)Ob' Q) Lvfi-RlA./IOKl< ~~ Ltl~ );:).;). t"lA..) @ /.17/ GI~(-DF."-.sA-C.
Facility: House-.i.- Mobile Home_ Business~Multi-family_ . Other: Tax Map or Pin Number 1/r;;:<ROI OR ;;l.? ?8'
Other . Zoning Approval #
# Bedrooms # Seats # Employees' , Application Rate ~ GPD Flow ~
Hot Tub or Spa yes 0 pecial Fixtures. Basemen@no ,lOO%Repair Are yes 0 . ..
Basement Plumbing es/ . . Water Supply: Private Well_ Pubhc'>C Se1lli-Pubhc_
.........*.**.*.**.*.******.*...****.*....*.**.*.*****************************************************~****************
Type of System: Trench==- Bed-==- Pump X Pump/Panel - Panel---=: LPP ~ Other :;;!,,- ~(") R {;J:> u (';T/)/I/ S9S,
Septic Tank Size Pump Tank Size ' Nitrification Field: Total Square Feet ____ Depth of-Stone _
Bed Size
~ Trench Width
Total Length of All Trenches
Number of Trenches
Trench Length ~/-=-/__ /=-/~/~ Feet on Center- Maximum Trench Depth ~ Distance of Nearest Well
*DO NOT INSTALL SEPTIC WHEN WET*, *WELL RECORD REQUIRED AT COMPLETION*
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Topo .? > % Slope
Texture CL;9-~f::Y
Structure $A1oi6
Clay Min. ) ; /
Soil Wetness
Soil Depth 9 t"
Restric.Hoz. atVr
1-
Available space~no
Overall Class ~
Comments:
*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) live 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 by the Health Department.' /'"' ~..... ,
Per1llit Date -pI-, t') EHS . U=: -S......:_~ J?, ,\.
Owner/Agent Septic Tank Installed By
EHS Well'lnsta led By
Well Head Approval Date Date Sample Collected
Date of Results Results
White c Office Blue - Building Inspection Operation Permit
Filter Required
Riser required when
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IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
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Date
Well Grout Approval Date
EHS
Yellow - Owner/Agent
Green - Building Inspection Authorization to Construct