HomeMy WebLinkAboutRBPR-05-2019-31900.tif
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Owner / Agent
Address
;v..- '- ~ CATAWBA COUNTY HEALTH DEPARTMENT p05kcl
Telephone (828) 465-8270 TDD (828) 465-8200 WLS # ZCJ0.3 .-OOZ35
OIlS ~rmt..)() Sys Type iJ(JJ Well Prmt. _ Replacement Well_Well Rpr Prmt.
<D J , we-- Phone I t-
311 Subdivision 1< kXJ ",::>
SectioplBlock/Phase
1./ c' 1':10..10
Property Address /7'L;y ~/k I)-y
Facility: House~ Mobile Home_ Business_Multi-family_ Other: Pin Number 3c;,5~-O/}"" ~if- 71d 7
Other Zoning Approval # AJ&.u~
# Bedrooms '- -) # Seats # Employees Application Rate . 3.5
Hot Tub or Spa yes/no Special Fixtures Basemen@no 100% Repair Are~/no
Basement Plumbing ~/no Water Supply- Private Well~ Public Semi-Public
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Type of System: Trench~ Bed_ Pump_ Pump/Panel_ Panel_ LPP~ Other
Septic Tank Size ({)1:Jl ~) Pump Tank SIze Nitrification Field. Total Squa:e Feet 1()3(,) Depth of Stone Il.
Bed Size Trench Width ~ 6 Total Length of All Trenches 3 '15 Number of Trenches <{
Trench Length ?1!lJ nJ S 7 / ,5/J; _/ _ Feet on Center Cj Maximum Trench DepWO -gG Distance of Nearest Well too
*DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION*
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Topo "(-It) % Slope
Texture (I ~
Structure /) ".
Clay Min, / ./ /
Soil Wetness ;6'5 _ "
Soil Depth ,/4( " I
Restric Hoz at - I
Available space!f1!,no I
Overall Class S SUI
Comments - ----I _.-
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Lot# -A-
Lot Size
4 0-8" '
GPD'Flow 3C2;:?)
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Filter Required
Riser required when
tank is more than 6
inches deep. I
**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
WILL FUNCTION**
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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 befor y portion of the installation is put into use.
The siting of tlie well by the Health Department staff is to provide protection from known ss' Ie sources of contamination. No volume of
water is guarante d at a I site by the Health Department. _ ("
Permit Date ,t. - . EHS //l _
Owner/ Ag nt I Septic Tank Installed,
EHS ,'of Well Installed~By
Well Head Ap~oval Date Date Sample Collected
Date of Results Results
Datel';'?'J'f~
Well Grout Approval Date
EHS
White Office
Yellow Owner/Agent
Pink Building Inspection Authorization to Construct