HomeMy WebLinkAboutRBPR-01-2023-43220.TIF 0
CATAWBA COUNTY'HEALTH DEPARTMENT
Telephone: (828).465 827 D: (828)4fi5 8200 • WLS # Oo - 0000 7
Improvement Permit AC Repair Permit. / Operation Permit System Typao Well Permit. Replacement Well
Owner/Agent (Y1 ao.. era.cla.tI - J Phone 10% - 0 -76- lei 34
Address a cif 5c,A Hojs�r Ra PO eiox S Subdivision
nk n n W ho .( } 1 h F
*ia. NIL. a 3{V6 Section/Bloc Ph se Lott/
Lot Size 4, 5 fQ Directions: . E-},.•.t,/ I O ( 3 f-I- L o r C,►"v r L r. Rc Li- P I ITs -o 1 eN tqa {Z.t o n f a
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Pro rt Address 11`-I Wq O• t y
1� Y � '� (..�1�+-a.� �d rt tic k o r
Facility: house Mobile Home •✓ Business Multi-family Other: Pin Number 3100 0-1 Lt t 44$50 l(
Other . Zoning Approval# _ •
#Bedrooms a #Seats #Employees . Application Rate GPD Flow 9 y'O
Hot Tub or Spa yes/no Special Fixtures Basement yesiO . 100% Repair Area yes@
Basement Plumbing yesi9 Water Supply: Private Well V Public Semi-Public
Type of System: Trench V Bed Pump Pump/Panel Panel LPP Other p)5 f o 1SQ,611L+-to
Septic Tank Size 100 o Pump Tank Size Nitrification Field: Total Square Feet 600 Depth of Stone —
y �
Bed Size Trench Width 3 t Total Length of All Trenches D00 Number of Trenches 43
Trench Length b6'/66 e/&0/ / I Feet on Center ' I Maximum Trench Depth Distance.of Nearest Well i Ub I
*DO NOT INSTALL SEPTIC WHEN WET*g *WELL RECORD REQUIRED AT COMPLETION*
Topa L C .5 % Slope 0`c
Texture -Na {�" � kne,p ca k pr4-S U S�p{ 1c.
Structure ° 4 F.; �` s y S fie.w..‘ r, , .
Clay Min.
9...
' 0 0/ P!u+"1 c+ny VJC.. 1 (Soil Wetness Ji �3 `
Soil Depth ,, , 7 ° t
RestricHoz. at " -j (aU3 j (O P^. F �/ 1^0 MQ"'
Available space yes/no .1�l t rr l i
Overall Class S PS U I (o t r°MZ 'P r a ¢ r* ( t ^ S
Comments: J. }���1 /r' �f" P. ,1' ^r� l r 1
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?� K Q.- ea 1 r Oct,S i ►12 0 t—O r aye r.)
Filter Required P
Riser required when b
tank is more than 6 , .
inches deep. 3oO,a�' W ot\ t.J11(.ee,( Qd.
**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE-PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
WILL FUNCTION** (o t0ij/-**************************************************************************************************** ******RT #O******
*Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the pro$osed
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.
Permit Date l` Q EHS
Owner/Agent _ Septic Ta Installed By auto ti-ei,,„.- Date 3 � I d_i a�
EHS W II Installed By Well Grout Approval Date Well Head
Appro jal Date - Date Sample Collected
Date of Results_ Results ,. ' , - , • EHS
White-Office Yellow-Owner/Agent Pink-Building Inspection Authorization to Construct