HomeMy WebLinkAboutRBPR-08-2014-19849.TIF CATAWBA COUNTY HEALTH DEPARTMENT ~ ~ ~
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Owner/Agent ~ V ~ I /1 QN ~ Phone
Address ~ ] %(Q ~ ~ Subdivision ` r(~~ Wl~'~ `
Section/B1ockCPhase Lot#
Lot Size Directions: j s (lzcc ~G ~ /St /'/is -t, u/U~
Facility: House K Mobile Home Business Multi-family .Other: Tax Map or Pin Number /D K - / - 5"~
Other .Zoning Approval # Z Q~'u~ Z~~
# Bedrooms # Seats # Employees .Application Rate D•¢ GPD Flow ~3~ ~
Hot Tub or Spa yes/Special Fixtures Basement yes~o .100% Repair Are/no C.o v'¢~
Basement Plumbing yes/no Water Supply: Private Well Public Semi-Public
Type of System: ``Trench Bed Pump Pump/Panel Panel LPP Other
Septic Tank Size I Pump Tank Size Nitrification Field: Total Square Feet Q~ Depth of Stone iZ ~nc,.~~
Bed Size Trench Width Total Length of All Trenches ~E}~ ~ Number of Trenches
Trench Length 75 / ~
' l 7~ l hs /l Feet on Center ~ ~ Maximum Trench Depth 36 ~ Distance of Nearest Well J~O
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Topo f % Slope I
Texture I
Structure , ' I
Clay Min. ~ ! I
Soil Wetness ~ I Z 3 / i
Soil Depth~~" I ~ I
Restric. Hoz. at'
Available space yes/no I t--
Overall Class S PS U ~
Comments: ~ ~ ~ ' ~G~S?
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**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGT OF TIME THIS SYSTEM
WILL FUNCTION**
'~IlnprQVenlent Pei'llllt lass ?iD expiration date a41d !S tCansfel'able, J?P3. _7?i ti " ~"e~'n1~Cil i~ _at•' ?,~q~s "fir P~pr ~ , u~r-P ¢ e r :4yr Q7+' ti,T2'!Jl"PLg6 f~ri
facility. ran Authorization to Construct is valid far (5) five years frown date issued and is not tr°aaisi'~rable. 4~s11 I~crmit alid for 5 ~•ears
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 pos 'ble sources of c~aiit,aPx~ination. No volume of
s ;4.~~q 9=.;~a~anteed at an~~ site bg' tlae Hea1Rl, Del~zr
Permit Date % - E /°e r/`
Owner/A t ' Septic Tank Install B - ~ - < Date .
EHS Well Installed By ~ Well Gro Approval Date •-)L ^
Well Head Approval Date Date Sample Collected
Date of Results Results ~ EHS ~
«'hite Of`ice Blue - Burl iron ]nst.eclion Operation Permit Yellow -Owner/ ~s rre~~ -Building spec[ion Authorizatio? w onstruct