HomeMy WebLinkAboutRBPR-10-2020-35947.tif
CATAWBA COUNTY HEALTH DEPARTMENT PDS!od
/ . Telephone: (828)465-8270 TDD: (828)465-8200 WLS# "L){)4:-0TJ{1'i
Improvement Permit-tL AC, Repair Permit. Operation Permit._ System Type_ Well Permit._ Replacement Well_
Own~r/Agent (;,!Tr;;h /).lvJ.lup~"ZF Phone, .
A'ddress {1~ f),).) CZ( Subdivision /"I/JV"\:.t..,.I1 (..riUl1 AMI-;-
Th.......,,'II.F F,rrcl !1/C run"') Section/Bloek/Phase Lot# 7-
Lot Size 0, KII.t Direetions: I {" r 1.,1- 101-'- I'!>~"IA'~ /'vI AT 1.(IrJ. Alt.. II!,' (f- ,.d~ Nfl (~th IltufJ.f..
Property Address 1\ +11. {,1\1.L(", N
Facility: House,L Mobile Home_ Business_Multi-family_ Other: Pin Number '.\6 'is 0'320" 170
Other . Zoning Approval # \,
{, 'l. I i'f () D
# Bedrooms 4 # Seats # Employees . Applieation Rate v. J GPD F ow "'l ~
Hot Tub or Spa yes/no Speeial Fixtures Basement@/no . 100% Repair Area yes/no
Basement Plumbing yes/no Water Supply: Private Well/ Publie_ Semi-Public_
************************************************************************************************************************
Type of System: Trerieh / Bed_Pump _ Pump/Panel V Panel_ LPP _ Other
Septic Tank Size
---
Pump Tank Size
Treneh Width
Nitrification Field: Total Square Feet
Depth of Stone -
Number of Trenehes
Bed Size
Total Length of All Trenehes
-
Treneh Length ~/ ./ / -/ =--/ ~/=- Feet on Center Maximum Trench Depth Distance of Nearest Well
*DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION*
***************************************************************************************************************************
Topo'!,':"S % Slope I
Texture C. I
Strueture S bh I
Clay Min. ,: I I
Soil Wetness I
Soil Depth '12. I
Restric. Hoz. at I
Available spaee ~/no I
Overall Class S@ U I
'Comments: ,. I
"'-
"'"
.->
~,
rv.,~/Y' AI'-2."
7 0' ;~->o'
. " f.I OIJJ.e..
I'lfl'-L AI1J-'1 I'
9Mt./ t0x ~ 0'
60kt ()
Filter Required
Riser required when
tank is more than 6
inches deep.
**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
WILL FUNCTION"
************************************************************************************************************************
;ulo'
A bv~ f/i/./\
C"iJJ-/'"
(J"
*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 any site by the Health Department. -t1 A n f ) ,{
Permit Date It, '2.'( -u ~ EHS /t' t.,..!4p: Ivl r'
Owner/Agent~)Y.-""'. =- Septie Tank Installed By
EHS '\ Well Installed By Well Grout Approval Date
Approval Date Date Sample Collected
Date of Results Results
White - Office
Date
Well Head
EHS
Yellow - Owner/Agent
Pink - Building Inspection Authorization to Construct