3.ot
Ap r. 18. 2011
2:56PM
l3UNcoMaE A
No. 5482 DEPMTM!l:NT
COUNTY HEALTH
cQU'··u" A
~,',""Fle
SUB-SURFACE
- ENVIRONMENTAl. SJi;WAQE
suca: /I.. tqeurlQAJ:i
..
Property Owner: ~a11ing Address: Property Location: , ~k Na\'Ae.> Water supply: SBcrlON
tkJiI)f)
Bt 'i
Well ~
ONE:
HEALTH SERVICES, (704-25S-3z'j SYSTEM IN A MBum (Jg)"
&.fm tf:
ZJ3'1O
lZ¥~
yOlu)C.
Uf&C/V C.
Mun~ctpal
OISPOSAL
P. 2
Application
Date;
(Shared
OTHER
De~lgn for: Ne~ System .Repair__ Residential Commercial Unit:!! No. muts No.B"'droom~/per ~nit ~ -Basement(a): Yes ~ No ----Ba$ement~ing: Y~s ~ No Permanent FoundatlonrB)~ Mobile (s) Singlewide Doublewide ------Available Space: Site classifio.!ltion, Soil Group. _ I,,'l'l\R: Design Flow ;~ _
B~TB EVALUATION Single
Unit
Sy~em
-L..
'l'ypeof Syst_. recommended
M\ll~~J:e
~refabricated Panel Large Dtameter Pipe (3) Bxpandcd Polyetyrene (1) (2)
Dlock
(4) Conventional ~
Agg~egate
::z:A.tj/All(fR: ~YuLe
(5)
Chamber
(6)
O~her
~
!?1QUA/TI1/"'/ /'J4PV,1IA CoM $ r~lIc'n/)A,)
~a'~4/~
AIl£/i 30
SltCT:Imt 'l"Wo: DES:IGN
Comment:iii:
D
o
x
"type of Systelll (#)~.r.e Liquid ca!;)ac:ity of Tank ltJ!)l> Trench Lengtb 'l'rench width Max Trench depth luniform and on contour) --~---------------in. 'Distrihution. Equal Serial '/StOM D~l'th N/A Pump Tank cap~ctty 'D~$tance Bet een ijell and system ' c.L V.
--:a
3.ot:!
No.
QJ;
T~enchaa
....•.. 3'''''=-.- __
Tz;ench 3pac/OC on lower Bldew~ll
2"
Oallls{Step Downs -=a-==---
_
"
This document includes all pertinent information applicable to an IMPROVJ!M2N'I' PBRMtT and shall be coned dexed as B\lch by the applicant. It the system is not in6talled within five years, applicant must apply fo~ a n~w A\l~horization to Cohstruct_
Imp~ovement Permit i6s~ed prio~
to tbts date.
Date o{ Xssuance:
---
This document authorize/;! the pJ:'opertyowner to construct a ground JUleo;qttion Sewage If1liJpoeiill SYetem. The owner MA'! ~tf.tljl& :l.nsEill.~1ng other types of systems ll~n.-n~ONE ahove. Changes from the above shall require Health Department approval. ~h18 Au~horizatlon to conaezuet, is Bubjec~ to ~evocaclon ,if the site plan 1s altered or the inten?ed use chans-es from tho5e indicated. The installer of thi" l!IyatOll'1 JII\IGt have a eopy of this doeum••• nt ,oll IIi ttl during all phases of
the insta11ation
Evaluated
and [illal i~spection.
•
By:
Owner/Agent,
Date.;
2:56PM
l3UNcoMaE A
No. 5482 DEPMTM!l:NT
COUNTY HEALTH
cQU'··u" A
~,',""Fle
SUB-SURFACE
- ENVIRONMENTAl. SJi;WAQE
suca: /I.. tqeurlQAJ:i
..
Property Owner: ~a11ing Address: Property Location: , ~k Na\'Ae.> Water supply: SBcrlON
tkJiI)f)
Bt 'i
Well ~
ONE:
HEALTH SERVICES, (704-25S-3z'j SYSTEM IN A MBum (Jg)"
&.fm tf:
ZJ3'1O
lZ¥~
yOlu)C.
Uf&C/V C.
Mun~ctpal
OISPOSAL
P. 2
Application
Date;
(Shared
OTHER
De~lgn for: Ne~ System .Repair__ Residential Commercial Unit:!! No. muts No.B"'droom~/per ~nit ~ -Basement(a): Yes ~ No ----Ba$ement~ing: Y~s ~ No Permanent FoundatlonrB)~ Mobile (s) Singlewide Doublewide ------Available Space: Site classifio.!ltion, Soil Group. _ I,,'l'l\R: Design Flow ;~ _
B~TB EVALUATION Single
Unit
Sy~em
-L..
'l'ypeof Syst_. recommended
M\ll~~J:e
~refabricated Panel Large Dtameter Pipe (3) Bxpandcd Polyetyrene (1) (2)
Dlock
(4) Conventional ~
Agg~egate
::z:A.tj/All(fR: ~YuLe
(5)
Chamber
(6)
O~her
~
!?1QUA/TI1/"'/ /'J4PV,1IA CoM $ r~lIc'n/)A,)
~a'~4/~
AIl£/i 30
SltCT:Imt 'l"Wo: DES:IGN
Comment:iii:
D
o
x
"type of Systelll (#)~.r.e Liquid ca!;)ac:ity of Tank ltJ!)l> Trench Lengtb 'l'rench width Max Trench depth luniform and on contour) --~---------------in. 'Distrihution. Equal Serial '/StOM D~l'th N/A Pump Tank cap~ctty 'D~$tance Bet een ijell and system ' c.L V.
--:a
3.ot:!
No.
QJ;
T~enchaa
....•.. 3'''''=-.- __
Tz;ench 3pac/OC on lower Bldew~ll
2"
Oallls{Step Downs -=a-==---
_
"
This document includes all pertinent information applicable to an IMPROVJ!M2N'I' PBRMtT and shall be coned dexed as B\lch by the applicant. It the system is not in6talled within five years, applicant must apply fo~ a n~w A\l~horization to Cohstruct_
Imp~ovement Permit i6s~ed prio~
to tbts date.
Date o{ Xssuance:
---
This document authorize/;! the pJ:'opertyowner to construct a ground JUleo;qttion Sewage If1liJpoeiill SYetem. The owner MA'! ~tf.tljl& :l.nsEill.~1ng other types of systems ll~n.-n~ONE ahove. Changes from the above shall require Health Department approval. ~h18 Au~horizatlon to conaezuet, is Bubjec~ to ~evocaclon ,if the site plan 1s altered or the inten?ed use chans-es from tho5e indicated. The installer of thi" l!IyatOll'1 JII\IGt have a eopy of this doeum••• nt ,oll IIi ttl during all phases of
the insta11ation
Evaluated
and [illal i~spection.
•
By:
Owner/Agent,
Date.;
