Caldwell EH Septic Permit

, Q- CALDWELL COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Permit #: ZJO&S
2345 Morganton Blvd, Lenoir, NC 28645
Office: [phone] Fax: [phone]
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (A.F.W.S.C.) A a�
Owner: DC.O -ft Leta
Property Address:. _ &.Z l
Subdivision (if applicable):
Properly Location: __JJ
t 224it NCPIN: 2-19N f#34391
.Section #: — Lot#: I
Improvement Permit Issue Date: 20L'L Associated Permits:
System Designed For: []New ❑Repair ❑Addition Establishment: esidence []Mobile Home 00ther
Design Flow: _LJJQ G.P.D. Number of Bedrooms: y Basement: Ii yes ❑ No
Source of Water Supply: ink; t Distance from Sewage System: t
Permit Conditions: Do Not grade or fill drain field or repair area.
4_ Contact Environmental Health if there are any questions ± concerning design or location of septic system.
Not to Scale 219
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Septic Tank Liquid Capacity:. j DO() Nit. Square Footage: 13 It No. Lines: q
Initial Drain Field Type 3S% A CO. •F- � LTAR: - 35 Repair Drain Field Type: S6% A60 _ LTAR: ;
Trench Length: Depth: %0 Width: ) I"{
B 3'� P _ _�� Saprolite: QYes ❑ No Pump System: Yes _❑ No r.�y
Dart",&A0' •w f Ifft41'- . f Flo"40.J
Notice: This A.F.W.S.C. is subject to all the provisions of Article II, G.S. 130A-133-399 and Laws and Rules for Sanitary Sewage
Collection, Treatment, and Disposal, Section 1900 of the N.C. Administrative Code. This A.F.W.S.C. is based on the site
evaluation/Improvement permit issued on 'i ?Oft . Any alteration of the site or changes made in the design, location, or use
of this system made after this date, unless specifically stated will immediately void this A.F.W.S.C. I understand the requirements of
this A.F.W.S.C. and the inforrr tion I have providgd is accurate to the best of my knowledge.
Qr�yL �y��Z _ ❑ Owner ❑ Agent
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This A.F.W.S.C. expires on: _ s described system has been installed. � Z / Z dzz,
Sanitarian: Issue Date: