HomeMy WebLinkAboutSFPR-10-2022-42588.TIF •
ENVIRONMENTAL HEALTH
Catawba County Government Center
25 Government Drive I P.O.Box 389 I Newton,NC 28658
Phone:(828)465-8270 Fax:(828)465-8276
catawba county
public health Email: EHAdmin@CatawbaCountyNC.gov
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Environmental Health General Application 11,r
Case# ( r oo4 01A) c'r'Sl��p Lbt- 7±1Q3�
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Property Location \(TO, TWA) k LL 1-(i[CI,C'/SI5 fA QYos4�kJ
Street Address: J \ C\ C c.L l\mos;' )S o o,L\ ; V Ch\F(
City: V o. e_ State: NC (� Zip: 2-'S k
Contact Person: O N <_S t-\ -4- V 1(Ar� �S J U(X'C•l,l�
Contact Phone Number:� `)c, —
Contact Email Address: rn>)C\ a-\A\(\\ ( l[\0�- \\ C_16\
Establishment Name: Q W TO,L C
Architect Name(if applicable):
Email Address:
Architect Address:
City: State: Zip:
Phone:
Please Note: Plans drawn to scale and specifications shall be submitted to the local health department for review and approval prior to
initiating construction.Plans drawn to scale and specifications for changes to building dimensions,kitchen specifications,or other modifications to
existing establishments shall also be submitted to the local health department for review and approval prior to construction.The local health
department shall visit or inspect an existing or proposed center,within 30 days of the request,to determine compliance.
Establishment Type
Child Day Care Lodging Bed and Breakfast Home Bed and Breakfast Inn
Residential Care Rest/Nursing Swimming&Wading Pools,Spas, School Building
Splash Pads /
Water Supply Type Individual Well ❑ Community Well E./Public Water ❑ Unknown ❑
Sewer Supply Type Individual Septic d Public Sewer ❑ Unknown ❑
All applicable information must be provided prior to submission. Contact Environmental Health for
applicable fees.
Applicant Signature Date
CATAWBA COUNTY HEALTH DEPARTMENT�N°v 6 0 3 5; ;
Telephone (828)465-827QFDD (828)465,1 .___�_,_ ,fr
Imp Print. v Au ,to Coast. �/ Rpr Prmt. Opr Prmt. Sys Type f.� Well Prmt. Well Rpr Prmt.
Owner/Agent 1 N !l N E. � V) Phone Y A,' +r f?
Address C/ -e- Subdivision
Sectionn/B19ck/Phase Loth
Lot Size Directions /O t.t.J1, f<
Facility. House Mobile Home Business //Multi-family Other. Tax Map or Pin Number A f, 77—of-- KS'
Other Cep, hi-p f-LQ.- Zoning Approval tf ?/V Qf�1 0 1 3 7
0 Bedrooms A'Seats 0Employees Application Rate .1.3 GPD Flow__Q4 Q
Hot Tub or Spa yes/no Special Fixtures Basement yes/no 100% Repair Area yes/no fr./Semi-Public
Basement Plumbing yes/no Water Supply t/Private Well Public Semi-Pubb
lic
************************************************************************************************ *** ********* **********
Type of System. Trench Bed Pump Pump/Panel . Panel LPP Other �^�'`'L d101� 3 ,y�
Septic Tank Size a6%g ) Pump Tank Size J000 Nitrification Field. Total Square Feet 7` "a of Stone e//4
Bed Size Trench Width 3J Total Length of All Trenches /3 7.S Number of Trenches / $'
105 fo.Ylof /05/CC /GS/OS/c, /o.. l //
Trench Length/9,5 I/4s I f63'11o,5'//q5'1/4y eet tin Center Maximum Trench Depth. 5 Distance of Nearest Well /CO
*DO NOT INSTALL SEPTIC WHEN WET*(55/If/e *WELL RECORD REQUIRED AT COMPLETION*
***************************************************************************************************************************
Topo 2---.3 % Slope
Texture .'" w l` L/ ���` �` ��:�
Clay Min. ' s,+" ‘'+�lStructure •
`-..�-�
Soil Wetness ' ;;
Soil Depth 3'a
Restric Hoz aty " _ `
Overall Class S UAvailable space no SF F t✓R I7 w7 / y
f
...____
Comments
1-40-fte-rili::
ef., ,,in
• l/o .` l ao G�" Al a
Sit . "Ad:Id-
tfyru2V" LAI Xrt.d HAt $41 -.' Ag*it'.
istivam 4.4_,A_ Ie,s4.1,2e,
Filter Required y
Riser required when ,
tank is more than 6
inches deep.
**NO GUARANTEE OR WARRANTY IS IMP IED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
WILL FUNCTION**
*Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed
.facility An Authorization to Construct is valid for(5) five years from date issued and is not transferable. Well Permit valid for 5 years
provided site conditions do not change. Well location, installation,and protection must meet state and local regulations, and must be
inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use.
The siting of the well by the Health Department staff is to provide protection from known possible sources of•contamination. No volume of
water is guaranteed at any sitc by the Health Department.
Permit Date y EHS
Owner/ ent ,.ta.Cc.c� Septic Tank Installed By bi 1+- - DateJ�.1-$=9 9-
EHSjt,. ,`� Well Installed By Well Grout pprovai Date
Well Head Approval Date Date Sample Collected
Date of Results Results EHS
White-Office Blue Building Inspection Operation Permit * Yellow 7 Owner/Agent Green-Building Inspection Authorization to Construct ,
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