HomeMy WebLinkAboutEHPR-6-11-11287 (2).TIF ���' � CATAWBA COUNTY HEAT� �H DEPARTMENT POS��
Telephone: (828) 465- �70 �`�DD: (828) 465-8200 WL'S�� — ��z`�
IP AC Rpr. Prmt. Op . Pr S s. �pe Well Prmt. Replacement Well Well Rpr. Prmt.
Owner/Agent � Phone
Address Subdivision
Section/Bl ck/P�ase Lot# I
Lot Size Directions: � e-t,� �G�-- —
:S� D ' '! •
Property Address Z GZL�'�
Facilit}�: House Mobile Home Business Multi-family . Other: Pin Number � � Q /
Other . Zoning Approval N
ft Bedrooms # Seats # Employees . Application Rate GPD Flow
Hot Tub or Spa yes/no Special Fixtures Basement o. 100% Repair Area yes/no
Basement Plumbing yes� Water Supply: Private Well� Public Semi-Public
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Type of S��stem: Trench Bed� Pump Pump/Panel Panel LPP Other
Septic Tank Size � /� Pump Tank Size Nitrification Field: Total Square Feet Depth of Stone 2 Cd7
Bed Size � x 7� Trench Wid[h Total Length of All Trenches Number of Trenches
Trench Length _/ /_/ / / Feet on Center Maximum Trench Depth Distance of Nearest Well
*DO NOT INSTALL SEPTIC R'FIEN WET* *WELL RECORD REQUIRED AT COMPLETION*
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Topo % Slope �
Texture �
Swccure � �J
Clay Min. �
Soil Wetness '
Soil Depth " � ' �
Res[ric. Hoz. at " � �/ \�
Available space yes/no �
Overall Class S PS U �
Commen[s: � �( .�,�
S'�'l'� /�cr,�~� `�� ��
in �
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Filtcr Required �
Riser required when �
tank is more than 6 � ��
inches deep. f
**NO GUARANTEE OR WARRANTY IS IMP RFORMANCE 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 fro kn possible ources of contamination. No volume of
water is guaranteed at any sit by the Health Department.
Permit Date Z — O E
Owner/Agent Septic Tank Installed Date � —
EHS We 1 Ins[ailed By Well Grout Approval Date
Well Head ` ppro��al a[e Date Sample Collected
' Date of Results Results EHS
White - Office Yellow - Owner/Agent "Pink �- f3uilding Inspection Au[horization ro Construct