HomeMy WebLinkAboutEHPR-04-2013-17165 (2).TIF
FlY: ,Other: Tax Map or Pin Number
Other , Zoning Approval #
# Bedrooms # Seats # Employees . Application Rate
Hot Tub or Spa yes/no Special Fixtures Basement yes/no ,100% Repair Area yes/no
Basement Plumbing yes/no Water Supply: Private Well_ Public_ Semi-Public_
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Type of System: Trench V Bed Pump Pump/Panel Panel LPP Other
Septic Tank Size~Pump Tank Size - Nitrification Field: Total Square Feet tfoiJ Depth of Stone Ic:l r /
Bed Size Trench Width {.3 f Total Length of All Trenches :J 00 Number of Trenches 3
Trench Length la / lto /lotJ / _/ _/ _ Feet on Center 9/ Maximum Trench Depth 3r;, 1'/ Distance of Nearest Well
*DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION*
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**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
WILL FUNCTION**
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CATAWBA COUNTY HEALTH DEPARTMENT
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GPD Flow
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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 epartment staff is to provide protection from known possible sources of contamination. No volume of
wate~ is guarante d t any site b e H lth Department. ~.~s:
PenmtDate EHS _ ~
Owner/ gen Septic Tank Installed By .... Date ~9 9-
EHS ' el nsta led By Wel Grout Approval Date
Well Head Approval Date Date Sample Collected
Date of Results Results EHS
White - Office Blue - Building Inspection Operation Permit Yellow - Owner/Agent Green - Building Inspection Authorization to Construct