HomeMy WebLinkAboutEHPR-08-2020-35447.tif
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CATAWBA COUNTY HEALTH DEPARTMENT N~ 7479
(828) 465-8270'R:' (828) 4651990_ ~
r Prme I Sys Type~ Well P~e Well Rp'r Prme
.... Phone j zcr=-{f(} 71
SubdivisIOn
Section/Block/P
e
Imp Prme
Owner/Agent
Address
FacilitY' House Business Multi-fanuly Other. Tax Map or Pm Number
Other Zoning Approval #
# Bedrooms # Employees ApplicatIon Rate ~ GPD Flow ~-<i'L(j
Hot Tub or Spa yes no Basement ye 100 % Repair Are 'es 0 \ /
Basement Plumbing y- 0 Water SupplY' ' Well_ Public...L- Semi-Pubhc_
******************* ****************************************************************************************************
Type of System. Trench ~ Bed ~ Pump _ Pump/Panel_ Panel_ LPP _ Other u
Septic Tank Siz~K-hf\~ Pump Tank SIze Nitrification Field. Total Square Feet Cl,vv Depth of Stone 1&
Bed Size 15 X LtC> Trench Width Total Length of All Trenches Number of Trenches
Trench Length_/_/_/_/_/_ Feet on Center MaXImum Trench Depth:S(y U Distance of Nearest Well.))
*DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPL
****** ***~*****************~*:or*~;&ttj~~j(~******************************************** *******************************
Tapa -0 % Slope I 'lV \V" j
Texture I ~lc?lir,
Structure I S JJ.
Clay Min, I
Soil Wetness - " I
Soil Depth~" I
Restric Hoz a~" I
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Comments I
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15 X Lt~ h..cJ
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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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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
water is guaranteed at y site by the Health Department. ~ /)0
Permit Dat r, - C<::::. , EHS _ _. ~ I '
Ow " ' eptIc Tank Install d he:.. Date" "10 -tI'J
EH "'- Well Installed By Wllil Grout Approval Date
Well He Date Sample Collected
Date of Results Results EHS
White - Office Blue Building Inspection Operation Permit Yellow " O~ner/Agent Green Building Inspection Authorization to Construct