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HomeMy WebLinkAboutEHPR-05-2014-19004 (2).TIF., IP~AC Owner/Agent Address 1 CATAWBA CO Y HEALTH DEPARTMENT P ~ Telephonf."` (828) 466-8270 TDD (828) 466-8200 WLS # o~ O J 3 - O t) ~ _Rpr Print. Opr Print. V Sys Type '~,~ Well Print. Replacement Well Well Rpr Print. rr , II (~n r+~ '" Phone ~~r^.Et- ~ A V - lei ~[~ J ~a W o cud S ~ U~. ~ ~,.Jj-o /~ l~l c.- ~GSY -- 6737 Subdivision Section/Block/Phase Lot# 7 (~ ~ Lot Size 1~. , '~ 4( Directions ~-{ w O P„J K ~- '~ , o r~ C ti.: rc. ~ (~ r~ . L~- ~` 1 1 nc.~l ~a~.J r[, h ii prCy PT ~h ~`~" BI1^L ' -/nom r ~~c ~ at` $-/~+PenL~ ~ - Property Address $ y ~' (jam-y,~ ~ e H ~ ~ e~ ~ i c.reo -, f Facility • House Mobile Home Business Multi-family Other• Pin Number ~ 'j cy) ~ ~ b, c~ O `°] 6 ~( Other Zoning Approval # # Bedrooms # Seats # Employees Apphcatton Rate ~ GPD Flow 3 ~-, to Hot Tub or Spa yes/no Special Fixtures Basement~no 100 % Repair Area ~no Basement Plumbing yes/~ Water Supply Private Well Public~Semi-Public *************************** *********************************************************************************************** Type of System. Trench Bed Pump Pump/Panel Panel LPP Other Septic Tank Size ~ p E) Ptunp Tank Si ze Nitrification Field. Total Square Feet ~ C ~ Depth of Stone ~ a t! Bed Size Trench Width ~. f Total Length of All Trenches 3 ®© Number of Trenches Trench Lehgth'®~~% ~t~o/~~?t~% // Feet on Center ~ j Maximum Trench Depth ~ ~ Distance of Nearest Well ~ yUf-~"(~- *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *************************************************************** *********************************************************** ~ ~ ` fi~ a nC ~ ~' C ~ ~ Topo i.: % Slope j - T u ~ ~ Ke, (~ c t ~ ~`'Fs V -~ " °~ ~ 1 2 ~' ~~ ext re ;jC. j~ ~ .p - Structure Sbk j ' ,s ,s~z M ~ ~ ~ t ~ ~ ^~ Clay Min. ~ 1 j Y Soil Wetness j Soil Depth a,4 ~, j /r ~ ~; i S t'~~ ,M ~-, o w•.2. Restric Hoz at _" ~ Available s ace no j a: .y Q R ~ ° f~''e' { / t ~a f ~ O ~ro ~"' ~~ v P =' ~'~y ~ " n2,J p Overall Class S P~U j C ~~ 1 ~[ 1 a, r I a~~ JS ( ~ ~p Co r~ c, n~ W~ ~ 1 o m ments j ~u . / l U ~ j e n~- ~ - , ~, a Y . t ~ S a. M ~ I ~~II ~ er a~ ~ ~~ .n~f c~r,d~. e val~r-E~ I ~ ~ y j 1 ~ - P F r .~ ~c,. ~ P~~~bi~~ in j C ~ drtv~. ®v~- y'S ,~ ~n5~-r+,~. n} LJ ~ ~ I ~ ~-~~~~~ pv~P j I 5 ~ ~ ~ c ~, ~r ~ ~~ ~ ~ ~! ~J <- P o.~ °°~ ti~ J o~ Q O -o 'T 15~- ~~X 3 i °~ 1 ~~ ~~ ~ 6 ~ ~'e-PG t ~' 9 ~ P~.r~ t~- 15 ~fl t~ ~nS~'~ l ~ ~ i neJ Z~ /'~ ~: ®tv~.f}' ~ ~~ Sur~'sc.Z Filter Required I _ J Riser required when j ' tank is more than 6 ~ ~, z. ~ ~ j ys ~ M inches deep. j **NO GUAR_ANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** ~a-{-I~~ r C (,~ v, ~,~ ~ ~ ~a *************************************************************************************************************************** *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 sources of contamination. No volume of water is guarantee at n}' site by the Health Department. "Permit Date 13~t;3 EHS t~ 1~"'wner/Agent ~ ~:....~ Septtc Tank I talled By t y-f- ~f'.3 Date I"0 f ~ U3 EHS ~ ~' - Well Installed By Well Grout Approval Date Well Head~pproval ate 6 ~ Date Sample Collected Date of Results _ Results EHS - White -Office Yellow O~~~ner/Aeent Pink Building Inspection Authorization to Construct