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Home My WebLink AboutRBPR-07-2013-17689.TIFTHIS IS NOT A PERMIT Case # RBPR-07-2013-17689 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Resid_ ential_Bu.i.ld.i.ng P1anJtevie"-- wimm.in.g-Eoo.l RUTH CONST -REPAIR - ABANDONMENT %01 10 Contact Person SUPERIOR POOLS, 20315 KNOX RD, CORNELIUS NC 28031 B:7048967665 C:5612131160 Contractor SUPERIOR POOLS OF CHARLOTTE, INC., 20315 KNOX RD, CHARLOTTE NC 28031-6585 B:(704)896-7665 C:7046158546F:(704)896-7773 PETE RJOHNSON 1222@YAHOO.COM Owner CHARLES TOMLINSON, 1077 KOKOMO KEY LN, DELRAY BEACH NC 33483 H:8282569050 HOME:8282569050 NAME TO APPEAR ON PERMIT Superior Pools of Charlotte, Inc. SITE ADDRESS: 4165 54TH AV NE, HICKORY NC 28601 PIN # 373512775101 NAME of SUBDIVISION: CHAS&VIVIAN BANDY\BRENT&MELISSA HAYE Lot # 1 Section/Block PROPERTY SIZE: Square Feet 81,457.20 Acres 1.87 DIRECTIONS: 4165 54th Ave, Hickory PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY : Public Water DESCRIBE WORK: "7/29/13 per MC need AC Repair charge $210 and Well abandoment no charge. 16 x 30 Pool, 35 x 20 concrete deck SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is "YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? No Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: ACCESSORY STRUCTURE FACILITY TYPE: Other OTHER DESCRIPTION: DESCRIPTION OF single family home EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 4 # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 16 x 30, 35 x 20 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Drilled FJ - chapplication 08/01/2013 16:28 Page 1 of 9 CATAWBA COUNTY Case # RBPR-07-2013-17689 F' �y Public Health Department Subdivision CHAS&VIVIAN BANDY\BRENT Environmental Health Division PIN# 373512775101 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Ig 2 SM NAME ON PERMIT: SUPERIOR POOLS OF CHARLOTTE, INC., 20315 KNOX RD, CHARLOTTE NC 28031-6585 Site Address: 4165 54TH AV NE, HICKORY NC 28601 Property Size: Square Feet 81,457.20 Acres 1.87 Directions: 4165 54th Ave, Hickory Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 MINIMUM SETBACKS FRONT: SIDE: FEENAME Improvement Permit (Existing) Fee Authorization to Construct (Repair) Fee Well Abandonment Fee TOTAL FEES REAR: MAX HEIGHT: DATE FEE AMOUNT 07/18/2013 $90.00 08/01/2013 $210.00 08/01/2013 $0.00 $300.00 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 1:9 - chaphlicallon 08/01/2013 16:28 Page 2 of 8 PAYOR Tomlinson, Janet PAYMENTS TRANSACTION NUMBER: PAYMENT DATE: PAYMENT TYPE: 98266640 INVOICE NUMBER 08-13-299106 CATAWBA COUNTY IOOA SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 PHONE: 828.465.8399 www.catawbacountync.gov TRC -277864-01-08-2013 08/01/2013 Credit Card TOTAL PAYMENTS: RBPR-07-2013-17689 FEE NAME Authorization to Construct (Repair) Fee RECEIPT Thursday, August 1, 2013 FEE AMOUNT $210.00 $210.00 CASE TYPE: Residential Building Plan Review WORK CLASS: Swimming Pool SITE ADDRESS: 4165 54TH AV NE, HICKORY NC 28601 Contact Person SUPERIOR POOLS, 20315 KNOX RD, CORNELIUS NC 28031 B:7048967665C:5612131160 Owner CHARLES TOMLINSON, 1077 KOKOMO KEY LN, DELRAY BEACH NC 33483 H:8282569050 Paid By JANET TOMLINSON, 10320 W ATLANTIC AV, DELRAY BEACH FL 33446 CATZOO@BELLSOUTH .NET **NO PEOPLESOFT ACCOUNT ASSIGNED ** Contractor SUPERIOR POOLS OF CHARLOTTE, INC., 20315 KNOX RD, CHARLOTTE NC 28031-6585 B:(704)896-7665C:7046158546F:(704)896-7773 PETERJOHNSON1222@YAHOO.COM E9 - receipt 08/01/2013 16:31 Page 1 of 1 Environmental Health Additional Fee Collection Notice The following additional fees as checked below must be collected prior to further action byour department Repair Permit Application | k Permit revision /re-dnamJ L� Well Permit L� Authorization toConstruct (system upgrades, etc) Other (please explain below) &n � ^ EH5 Date 7 "D1,3 » ~ THIS IS NOT A PERMIT Case # RBPR-07-2013-17689 CATAWBA COUNTY HEALTH DEPARTMENT 0i0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES P=�� Residential Building Plan Review - Swimming Pool IMPROVEMENT F13-1 Contact Person SUPERIOR POOLS, 20315 KNOX RD, CORNELIUS NC 28031 _ 13:7048967665 C:5612131160 _ _ Contractor SUPERIOR POOLS OF CHARLOTTE, INC., 20315 KNOX RD, CHARLOTTE NC 28031-6585 B:(704)896-7665 C:7046158546F:(704)896-7773 P_ETERJOHNSON I222@YAHOO.COM Owner CHARLES TOMLINSON, 1077 KOKOMO KEY LN, DELRAY BEACH NC 33483 H:8282569050 HOME:8282569050 NAME TO APPEAR ON PERMIT Superior Pools of Charlotte, Inc. SITE ADDRESS: 4165 54TH AV NE, HICKORY NC 28601 PIN # 373512775101 NAME of SUBDIVISION: CHAS&VIVIAN BANDY\BRENT&MELISSA HAYE Lot # 1 Section/Block PROPERTY SIZE: Square Feet 81,457.20 Acres 1.87 DIRECTIONS: 4165 54th Ave, Hickory PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY : Public Water DESCRIBE WORK: 16 x 30 Pool, 35 x 20 concrete deck SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is "YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? No Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: - ----- ____ ......___� ACCESSORY STRUCTURE FACILITY TYPE: Other OTHER DESCRIPTION: DESCRIPTION OF single family home EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 4 # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 16 x 30, 35 x 20 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: EQ - chapplieauon 07/18/2013 11:35 Page I of CATAWBA COUNTY Case # RBPR-07-2013-17689 Public Health Department Subdivision CHAS&VIVIAN BANDY\BRENT Environmental Health Division PIN# o, 373512775101 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 NAME ON PERMIT: SUPERIOR POOLS OF CHARLOTTE, INC., 20315 KNOX RD, CHARLOTTE NC 28031-6585 Site Address: 4165 54TH AV NE, HICKORY NC 28601 Property Size: Square Feet 81,457.20 Acres 1.87 Directions: 4165 54th Ave, Hickory Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 MINIMUM SETBACKS FRONT: SIDE: REAR: MAX HEIGHT: FEENAME DATE FEE AMOUNT Improvement Permit (Existing) Fee 07/18/2013 $90.00 TOTAL FEES $90.00 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) FQ - .happlication 07/18/2013 11:35 Page 2 of 4 THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT lY Application for Environmental Services Pace I Improvement Permit Authorization to Construct 7 Septic Repair F-1 Septic Malfunction E] Septic Expansion 7 New Well Permit 0 Replacement Well 7 Well Abandonment ❑ Well Repair Fj Existing System Inspection (Pre -Approval Required) JE-_ Application is for New Construction Existing Facility - Property Address L41& -s Subdivision Lot # Acres Section/Block/Phase Driving Directions to Property C 1 -- LU CL A vi'0", 'A" -P-P_E A R, -0, "P, , E"', 11", IN',' I "I _ r, ...... L,-],, '0''' N v"ner'", 1" X"Plpli-c"a,rit LHton"trac't'o'r .... ........ .. .. . . .... ...... .... . ...... AO pplicant Contact Information I Narric f -,f jei SKItIr Address C c" A I Phone CellPhone Owner Contact Information Narric ON\. It\ 13 C Address Lill_5 . A A E C Phone 9) `, -a C) 5 Cell Phone Contractor Contact Information Narric 'y V) Address r It P11-11 L4 ; I 1, D C- WHO WILL BE THE PRIMARYCONTACT? F-1Owner E:1 Applicant Q Contractor .. ..... ........ ... ... ... ....... .... O .. ..... Description of Existing Structures on Site I "-DimensiA*i->-, ft of Bedroorns *t- Ll Structure ons 9 of Occupants Basement F�q"�es F� No Basement Fixtures D'�cs F� No _1� c c, Planned" Future r, (Building. P,ri c,i)1t,"NOT req,"u-csted at this tin e) Describe Proposed Future Structure Dimensions # of Bedrooms *I it'applicable Are there casements or right-of-ways rectyrded on this property ❑ Yes ❑ No Describe Is a public water supply available on or adjacent to the above property ❑ves 0 No Check type available E] Community Well ❑ Scini-Public Well ❑ County/City/Township Water Line Cris 0�,vater supply in use R Individual WC11 F-1 Community Well ❑El Serni-Public %Vell County/City/Township Water Lille ❑ I WOULD LIKE TO SCHEDULE A CON113INED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) .. . ...... .. THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application' for Environmental Services Page 2 �pp�� 18, 1- r(\'VAP ' sed Facility Type 1 ,''Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t - Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe hIM ( TP —twee k- ek.e(I- * + it�00 ��vvl , ab # of New Bedrooms t if � Stricture Dimensions .�1G rP.Cr'1i,ef.K, # of Occupants C'} Accessory Dwelling ❑ Yes 0 No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ ttilulti-Family Residence # Units #Bedrooms per Unit*' Total # Bedrooms *t Structure Dimensions ❑ Food Service Spccify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes ❑ No If` Daycare Spccify Occupancy .Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Senu-Public Well Abandonment Type ❑ Drilled ❑ Bored Well Repair Requested ❑ Yes ❑ No Describe ❑ Community Well ❑ Dug ❑ Unknown Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation Nvith on- site staff. *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted visa bedroom and counted on all applications. The cumber of'bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. tf f structure is plumbed but no bedrooms, calculated design flow is required. ** If No, a well permit must be issued with the .Authorization to Construct. Note: You must obtain Zoning approval prior to locating a ]tome or stnicture on this property. .Any representation by you of house or structure location should conform to applicable setbacks. Q CHANGE NVORK ORDER REQUIRING REDESIGN AND/OR RETRIP NVII. I, INCURE AN i-- ADDITIONAL CHARGE (SEE FEE SCHEDULE) W '4 1 understand that this is a formal application for Environmental Services and authorize Catawba County Environmental Health employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement permit issued as a result of this information is valid for 5 years or may be non -expiring, under certain U specified conditions. Improvement Permits and Well Permits are transferrable. but may be revoked i`:'this information, site W plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for CC) (5) five years from the date issued and is not trans4r}able j Signature of Owner or Agent Printed Name of Owner or Agent,/ ez1 Date 7�L — I 'rtbcr M N0 ;'29 4 41-4 75' 97)" F.— S(-,2'00'06:�W 341.F;,5* Lot 1 4c t , pp X9 S02-010 00"W pp 44,85' Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map Catawba County promotes and recommends the independent verification of any data contained on this map product by the user. The County of Catawba, its employees, agents and personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map product or the use thereof by any person or entity. Selected Parcel Number: 3735-12-77-5101 1 inch = 60 feet Prepared for: "Y / _ _ ✓ (0,I - °7 _ 2 �? 00 31.61 49.1 � 9 ,N— c� 6 27: 6 33.10 0..,.28 31 35.51 co LQ _.,�.�. �.,_.__._��..w_.,.,.•�..k_.�--1.......� �-------� 1.2'1 A�� - ' .07n co W 1.03A cu i 5101 °° 047-« �- �(Y) I d- I 4 I Plat 69-128 I '„t, g 1 I 1 Qf / THIS IS NOT A LEGAL DOCUM l— Date: 7/17/2013 T/�me:- 4:01:17 PM 0 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3735-12-77-5101 Name: TOMLINSON CHARLES Name2: TOMLINSON JANET Address: 1077 KOKOMO KEY LN Address2: City: DELRAY BEACH State: FL Zip: 33483-6035 Account: Calc Acreage: 1.87 Tax Map: 0200 23046 LRK: 21343 Deed Book: 3018 Deed Page: 1199 Subdivision Name: CHAS&VIVIAN BANDY\BRENT&MELISSA HAYE Subdivision Block: Lots: 1 Plat Book: 69 Plat Page: 128 Building Number: 4165 Street Name: 54TH AV NE Site Zip: 28601 Township: CLINES Fire Dist: ST STEPHENS Citylfax: State Road: Total Bldgs Value: $853,600 Land Value: $158,200 Total Value: $1,011,800 Year Built: 2010 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 58 Watershed: Watershed Split: NO Voter Precinct: P33 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: CRC-O,FPM-0 Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: SNOW CREEK Middle School: ARNDT High School: ST STEPHENS School Split: NO P&Z Case Number: Census Tract 2010: 010301 Census Block 2010: 1000 Small Area Plan: ST STEPHENS/OXFORD Agricultural District: Printed: Wednesday, July 17, 2013 04:08 PM o i P -k � stt t)4 loceqed pry arc PcA Met SqA CATAWBA COUNTY Public Health Department Environmental Health Division PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Applicant/Owner CHARLES TOMLINSON Site Address: 4165 54TH AV NE, Hickory, NC Property Size: SF ACRES Directions: Case # OP -12-10-13505 Subdivision Lot # PIN# 373512775101 Catawba County Health Department Operation Permit IIIG - OTHER NON -CONY TRENCH SYSTEMS System Type: (In accordance with Table Va) Description: 25% REDUCTION Types V and VI systems expire in 5 years. Owner must contact health department 6 months prior to exiration for permit renewal. System Installation Comments: PERMIT CONDITIONS: 1. All maintenance, monitoring, and performance requirements shall be in accordance with 15A NCAC 18.1900, Rule .1961 2. Operation & Maintenance Specifics: Subsurface system operator required? Yes No_X If yes, see attached sheet for additional operation conditions, maintenance and reporting. This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and All conditions of the Improvement Permit and Construction Authorization. Speciality Septic SYSTEM INSTALLER Susan Bunagarner - 91919 AUTHORIZED STATE AGENT 12/07/10 09:18 12/03/2010 INSTALLATION DATE 12/06/2010 DATE OF OPERATION PERMIT ISSUANCE Form F V -S CATAWBA COUNTY Case # AUTH-7-10-9644 Public Health Department r; Environmental Health Division Subdivision CHAS&VIVIAN BA��IDY\BR PO Box 339, 100-A Southwest Blvd, Newton, NC 23653 Lot # 1 �tg PIN# 373512775101 Applicant/Owner CHARLES TOMLINSON Site Address: 4165 NE 54TH AV, Hickory, NC Property Size: SF 1.87 ACRES Directions: SPRINGS RD TO LEFT ON SULPHUR SPRINGS RD, LEFT ON 37TH ST DR, RIGHT ON 54TH AVE NE, ON LEFT OF DIXIE BOAT CLUB Authorization to Construct Permit Authorization to Construct Wastewater Svstem (Reauired for Buildina Permit) * See site plan and number of additional attachments Proposed Wastewater System: 25% REDUCTION Wastewater Flow 430 g.p.d Type: IIIG - OTHER NON -CONY TRENCH SYSTEMS Soil LTAR: •3 g.p.d.lft2 Permit Category: New Septic Type of Facility: House Basement? Yes Basement Plumbing? Yes Bedrooms: 4 Wastewater Svstem Reauirements Tank Size: New Tank 1,000 gal Pump Tank gal Grease Trap gal Dosing Volume gal Pump Specs: GPM @ TDH Pressure Head ft Draw Down in Drainfield: Total Area: 1,200 sq ft Total Length: 400 ft Maximum Trench Depth 24 in Aggregate Depth in Trench Width 3.0 ft Minimum Soil Cover 6.0 in Minimum Trench Separation 9.0 ft on center Number of Drain Lines 4 Distribution: Serial Additional Specifications: Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains, is not ammroved, and may result in failure to approve the initial system installation, or the suspension/revocation of existing permits. Proposed Repair System Class: IIIE Proposed System: 50% REDUCTION Distribution Type:: Distribution Box Soil LTAR: •3 q.p.d.M2 The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Authorization to Construct Permit is subject to revocation if the site plan, plat or the intended use changes, or if site conditions are altered. The Authorization to Construct Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws and Rules for Setvaoe Treatment and Disposal &stems' (15A NCAC ISA .1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Susan Bumgarrler 07/28/2010 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 07/27/2015 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. 07/23/10 1 l : l 5 to - jv ? 05118 C ANr AnL W 0 AFk C C) U W -r 5- HET, -r M CnF>1AnrrM0"rr (704) 465;:8270 Lot Eval. X improve. Permit epair Permit Cert. of Comp. Permit ko per. Permit Owner/Agent Phone Address i Subdivision Section/Block/Fhase Lot# Lot Size Directions: 0.0:* A/A ct-, -5A&,-0 I P /Zo 3 5-1 Be 1r4j2L(f0_V_06I?) -3 / 1 ivj�, Facility: House-,,L Mobile Home X Business Other: Zoning Approval(2jD/no #lei m Multi-family Other Tax Map # ZVO-0 —ql(o Bedrooms. Seats Employees Application Rate m."(- GPD Flow:. 6.D Hot Tub or Spa yes6ib Special Fixtures 100% Repair Area yes/no REPAIR NOTICE. Basement yes r9 Basement Plumbing yes/dp. REPAIRS MUST BE WITHIN 30 DAYS OR Water Supply: Private Public DAYS FROM DATE OF PERMIT. Type of System:. Trench _,,.__Be d_Pump_Pump/Panel Pane1LPP Other Tank Size: Septic Tank &z Pump Tank Nitrification Field: Total Square Feet Depth of Stone IJM�.L Bed Size Trench Width S 7P, Total Length of All Trenches 3M Number of Trenches Individual Trench Length 1C011001 Feet on center Maximum Trench Depth 3 Z Distance of Nearest Well Lot Evaluation: Approved yes/no (Void After 24 months) Topo z s Slope Sketch of lot Evaluation Site System Design Final Texture Uan structure ITI Clay Min. IN Soil Wetness 10 Soil Depth f Restric. Hoz. at Available space es/no) PP Overall Class SC U Comments: 115 Mobile. d& Septic Tank Contractors MUST contact the Sanitarian BEFORE changing permit. **NO GUARANTEE.OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF 'PHIS PERMIT" Permit Date ?3 (Impro id ter 60 months) Owner/Agen�. Sanitar, Installed By_MfY- Date 2,-3-93 Sanitari.-V (Note any changes/information in red or by sketch WfjacW *******IF A PERMIT' HAS TO BE REDESIGNED AND/OR RETRIPS MADE To THE&pRopERTy, THM******** IS AN ADDITIONAL $25 CHARGE. White-Office Blue-Bldg. Insp. Comp:", Yellow-Owner/Agent Green-Bldg. Insp. I.P.