HomeMy WebLinkAboutRBPR-12-2012-16600.TIF
-- -
~7 )} ~ \'1D jO'r'c -
cy/~ ' .. ( CATAWBA COUNTY HEAltTlI DEPARTMENT ~05ted
/" Telepho~e:A828) 465:A27)VDD: (828) 465-8200 WLS#2I)() I -oOQ73
IP AC t/R~ Ipr. P t.~O r. prmt.-LSys. Type';4:I:J_Well Prmt._Replacement Well Well Rp'r. Prmt.
Owner/Agent ~~ _ Phone ~~)f'~1
Address 11.J..5 . , pJ.." ,. Subdivision '....€/IA-l/ ~ ~~
Section/Block/Phase LotH;L....
r-;
Property Address I r .' .
Facility: Hou", _ Mobile Home _ Buslle" _Multi-family _ . Oth~: Pm NWUb"'a~ ~f-~ ~ 0 ,. /
Other . Zomng Approval # __ _ _ 0___'__ tJ_ q _
# Bedrooms...3 # Seats # Employees . Application Rate 6 GPD Flow J; 0
Hot Tub or Spa yes/no Special Fixtures Basement ~no . 100% Repair Area@o
Basement Plumbing yes~ Water Supply: Private Well_ Public~emi-Public_
******************************************************************************************************** *****************
Type of System: T~ench_Bed_Pump_Pump/panel_panel_LPp_Other :2~ ~
Septic Tank Size4 fJoo ~ Pump Tank Size Nitrification Field: Total Square Feet 9 O(J
Bed Size Trench Width < 3' Total Length of All Trenches (?O{) / Number of Trenches '/
Trench Length -'j / 7 r /1/ .:tJJ _/ _-;;eet on Center 9- Maximum Trench Depth ") G Distance of Nearest ~ ell t!Ott-:-r-
*DO NOT INSTALL SEPTIC WHEN WET* *WELLlUOCOiID REQUIRED AT COMPLETION*
***************************************************************************************************************************
Topo ).- I --,1 () ~ <\'_- oJ
Texture I v~ ~.-"I-
Structure I ~ ,. "" ~ . ~
Clay Min. I' ~
SoilWetness N~ I , ~
Soil Depth ' I ~
Restric. Hoz. at I j
Available space 1 (
OveraJJ Class S ,
Comments: 1 d... <9 0
1
I
1 ;'
1
I
I
1
I
I
I
1
I
I
I
I
1
I I
R WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
~*
~~rl
'-(f7p ~
;;C~~
r~
Filter Required
Riser required when
tank is more than 6
inches deep.
**NO GUARANTEE
WILL FUNCTION**
t
~
{
loD
~
G ~ --.:::y-
~~
f'~
~
~
~A'~ ~_-
~<;;./-7""'?-- 0
***************************************************************************************************************************
*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. WeJJ 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 instaJJation 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
wat~r is guaranteed at ny' site by the He lth Department. 1"2 __~- '. /11'/ C
~~ ~~. &X
Owner/ ent. Septic Tank Installed By ... Dat~'-c; (
EHS Well Installed By Well Grout Approval Date
Well Head Approva Date Sample Collected
Date of Results Results
White - Office Blue - Building Inspection Operation Permit
Yellow - Own~/J}g\:nt.,
EHS
Green - Building Inspection Authorization to Construct