HomeMy WebLinkAboutEHPR-04-2022-40601.TIF
CATAWBA COUNTY HEALTH DEPARTMENT I
" Telephone (828) 465-8270 TDD (828) 465-8200 WLS # :J..OO~ - ()(J 990
Improvement Permit~ AC_ Repair Permit._ Operation Permit._ System Type_ Well Permit._ Replacement Well_
Owner/Agent -fEt "!'1)1lI~ Phone
Address 'TER.I!. fJ/N RJpG-E' IZDA-:D Subdivision Oc..-J) /J?/f.,<.J StlJ3.D
C - LV c... {) Section/Block/Phase LotH ~
Lot Size () .t,t;Ac-IZt:>Directions is-a ~ <.. O(.b !s -
c.,6 tv "& ~) DF
:#: Q Q..v@ uv c,t.lL.,j:)t-..Sl9C. Property Address 13CJ.O 'TCI2~P/. ~)J)o..,eR.OIJ.D
Fadll'y' Hou," X- Mobil, Home _ Bu,,,,,,, _ Multi-fumily _ Olli",' Pm Numb" J.j 'J/J 0 I .;>. '7 D ? :
Other Zoning Approval # /9
# Bedrooms 3 # Seats # Employees Application Rate " -3 GPD Flow GO
Hot Tub or Spa ye~pecial Fixtures Basement yesG!iil. 100 % Repair Area ~
Basement Plumbing yes~ Water Supply- Private Well~ Public_ Semi-Public_
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Type of System: Trench ---. Bed--=::::::.....- Pump-====- Pump/Panel-X- Panel - LPP ~ Other
Septic Tank Size Pump Tank Size Nitrification Field: Total Square Feet -
fJ~
Depth of Stone
Bed Size
---.
Trench Width ----
Total Length of All Trenches -
Number of Trenches .
Trench Length ~/ ~/ ~/ ~/ ~/ -=-- Feet on Center
*DO NOT INSTALL SEPTIC WHEN WET*
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Topo g'5 % Slope .1...," ~,
Texture c~7' 1
Structure ~ I
Clay Min. I.' / I
Soil Wetness " 1
Soil Depth 'I.;. "I
Restric Hoz at 0/..2." 1
A vailable space ~ I
Overall Class S
Comments.
Maximum Trench Depth ~ Distance of Nearest Well .sv ~
*WELL RECORD REQUIRED AT COMPLETION*
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Filter Required
Riser required whe
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NTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR ENGTH OF TIME T IS SYSTE
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*Improvement Permit 0 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. ______ '-
P,nuitD", 9f- S- ~C/ EHS CO :?~-- -~, R .5
Owner/Agent 13 ~ ~ Septic 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