HomeMy WebLinkAboutREF-000035034.tif+' ~ CATAWBA COUNTS HEALTH DEPARTMENT ~ ~ _ . 7 4 4 5 ,
Telephone: (828) 465-8270 TDD: (828) 465-8200 p~j~~
Imp. Prmt. Auth. to Const. Rpr. Prmt. Opr. Prmt. Sys. Type Well Prmt. Well Rpr. Pant.
Owner/Agent ~'!~ ~ ~ Phone ~. /- . ~~~
Address Subdivision
- -~r -~/ Sectio~lock/Pha Lot#
Lot Size /3 ~ Directions: f / ~ L /-~.,i ./T ~~ ~~ /r//J ~~,!~~ na
Facility: House Mobile Home Business Multi-family .Other: Tax Map o t Numberv~~ - ~ -~ 7.. ~p/~
Other .Zoning Approval #
# Bedrooms # Seats # Employees .Application Rate GPD Flow
Hot Tub or Spa yes/no Special Fixtures Basement yes .100% Repair Area yes/no
Basement Plumbing yes/no Water Supply: Private Well Public Semi-Public
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Type of System: Trench
Bed Pump
Pump/Panel Panel LPP Other
Septic Tank Size
Bed Size
Pump Tank Size
Trench Width
Nitrification Field: Total Square Feet
Depth of Stone
Total Length of All Trenches
Trench Length -/ //// Feet on Center
*DO NOT INSTALL SEPTIC WHEN WET*
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To
o % Slo
e J
-
~9
p
p
Texture q
,
~ j
Structure ~
Clay Min. ~
Soil Wetness
' ~ l Imo, p'
W
Soil Depth • ~
Restric. Hoz. at ~
Number of Trenches
M ximum~e Depth Distance of Nearest Well
*WEL CORD REQUIRED AT COMPLETION*
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Q- V
Available space yes/no ~ -~ ^~ l ~ ~ --
Overall Class S PS U ~ ..__ ! 0 U ( S~ arc S7S
Comments: ~ - - - - ~- ~ - ~ _ - - - -
~- bbl ~.,
I
j ~~ ~
J
~~~P
~, fQ~ ..~ ~~--
Filter Required ~ {~
Riser required when ~ ~'° n Sl~
tank is more than 6 ~ ~ ~Y ~ j
inches deep. ~ -
**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
WILL FUNCTION**
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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 s ce of contamination. No volume of
water is guaranteed at any site by the Health Department.
Permit Date EHS
Owner/Agent ~ Septic Tank sta e y Date
EHS ell Installed By v~ , Well Grofit pproval Date-~?
Well Head Approval Date ° 7--- I Date Sample Collected
Date of Results Results ~ EHS/~G~,~L ~ ~iLL ,~^- ~~-"~
White -Office Blue -Building Inspection Operation Permit Yellow -Owner/Agent Green - Buildingt pection Authorization'o Construct