HomeMy WebLinkAbout20031479 Ver 1_COMPLETE FILE_20031121
W ATFh'
tu&-i
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
Christopher S. Rockwell
23615 W. River Road
Grosse lie, MI 48138
December 8, 2003
DWQ # 03-1479
Pamlico County
Page 1 of 2
Subject Property: Rockwell Residence, Lot 10, Cartwright S/D, 1110 Fork Point Road, near Whortonsville, NC
Ship Creek [03-04-10, 27-141-1 ] & Broad Creek [03-04-10, 27-141 ],
SA (Suitable for Shellfishing) HQW (High Quality Water) NSW (Nutrient Sensitive Water)
APPROVAL of Neuse River Riparian Buffer Protection Rules MINOR VARIANCE [15A NCAC 2B.0233(9)(b)]
Dear Mr. Rockwell:
You have our approval, in accordance with the conditions listed below, to impact approximately 213 square feet (ft2 ) (or
0.005 acres) of Zone 2 of the protected buffers to construct a house and deck at the subject property as described within
your variance request dated October 23, 2003 and received by the Division of Water Quality (DWQ) Wetlands Unit on
November 21, 2003. This letter shall act as your Minor Variance approval as described within 15A NCAC 2B .0233(9)(b).
In addition to this approval, you should obtain or otherwise comply with any other required federal, state or local permits
before you go ahead with your project including (but not limited to) Erosion and Sediment Control and CAMA regulations.
This approval is only valid for the purpose and design that you described in your application. If you change your project,
you must notify us and you may be required to send us a new application. If the property is sold, the new owner(s)
must be given a copy of this variance approval and is thereby responsible for complying with all conditions. For
this approval to be valid, you must follow any conditions listed below.
Conditions:
1. Buffer Mitigation (WRP)
You are required to mitigate for impacts to the protected riparian buffers. The required area of mitigation to
compensate for impacts to the protected riparian buffers is 319 square feet as required under this variance
approval and 15A NCAC 2B .0242. We understand that you wish to make a payment into the Riparian Buffer
Restoration Fund administered by the NC Wetlands Restoration Program (WRP) to meet this mitigation
requirement. This has been determined by the DWQ to be a suitable method to meet the mitigation requirement.
In accordance with 15A NCAC 2B .024Z, this contribution will satisfy our compensatory mitigation requirements
under 15A NCAC 2B.0233(9)(C). Until the WRP receives. and clears your check (made payable to: DENR -
Wetlands Restoration Program Office), no impacts specified in this variance approval shall occur. Mr. Ron Ferrell
should be contacted at (919) 733-5208 if you have any questions concerning payment into the WRP. For
accounting purposes, this variance approval authorizes payment into the Riparian Buffer Restoration
Fund to compensate for 319 ft2 of required riparian buffer mitigation for impacts to 213 ft2 of protected
riparian buffers; 03-04-02, 27-43-(1) river and subbasin."
The DWQ will also accept an alternative method of mitigation (including but not limited to Buffer Restoration or
Enhancement) pursuant to the Buffer Mitigation Rule (15A NCAC 02B.0242) to satisfy this mitigation
requirement. If you choose to pursue this option, then you are required to submit in writing a mitigation plan to the
DWQ Wetlands/401 Unit for review and approval. No impacts shall occur to the protected buffers until the
mitigation plan is approved by the DWQ.
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
non - -- /..4.....,.? n{n'00 &onn Is-A M?a...//Mn...-.....ss...-....../.-
Christopher S. Rockwell
Page 2 of 2
December 8, 2003
2. No Zone 1 Impacts
No impacts (except for "exempt" uses as identified within 15A NCAC 2B .0233) shall occur to Zone 1 of the
protected riparian buffers unless otherwise approved by the DWQ. No impervious surfaces shall be added to
Zone 1, unless otherwise approved by the DWQ.
3. Diffuse Flow
An additional condition is that all stormwater shall be directed as diffuse flow at non-erosive velocities through the
protected stream buffers and will not re-concentrate before discharging into the stream as identified within 15A
NCAC 2B.0233(5).
4. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent modifications, the applicant is required to return the attached certificate of completion to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.
5. Protective Fencing
The outside buffer boundary and along the construction corridor within this boundary approved under this
authorization shall be clearly marked with orange fencing (or similar high visibility material) for the areas that Dave
been approved to infringe within the buffer. This fencing shall be installed prior to any land disturbing activities to
ensure compliance with 15A NCAC 2B .0233. The protective fencing should be removed once construction is
complete.
Requests for appeals of this decision shall be made to the Office of Administrative Hearings. If you do not accept any of
the conditions of this approval, you may ask for and adjudicatory hearing. You must act within 60 days of the date that
you receive this letter. To ask for a hearing, send a written petition which conforms to Chapter 150B of the North Carolina
General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714. This
approval and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under the Neuse River Riparian Buffer Protection Rules
[15A NCAC 2B .0233(9)(b)]. Please call Mr. Bob Zarzecki at (919) 733-9726 if you have any questions or require copies
of our rules or procedural materials.
Sincerely,
Attachments: WRP Notification
fr,DrIW , PE,
cc: Jerry L. Walker, the Walker Group Architecture, Inc., PO Box 541, New Bern, NC 28563
Stephen Lane, DWQ Washinton Regional Office
File copy
Central Files
DWQ031479
December 8, 2003
bz
O? `NAr?9
t3 Y
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, PE, Director
Division of Water Quality
NORTH CAROLINA DIVISION OF WATER QUALITY
Minor Variance Approval
SUMMARY OF PERMITTED IMPACTS AND MITIGATION REQUIREMENTS
In accordance with 15A NCAC 2B .0233, Christopher Rockwell has permission as outlined below and within the
attached variance approval to impact buffers for the purpose(s) of constructing a house within Zone 2. All activities
associated with these authorized impacts must be conducted with the conditions listed in the attached authorization
certificate. THIS VARIANCE APPROVAL IS NOT VALID WITHOUT THE ATTACHMENTS.
COMPENSATORY MITIGATION REQUIREMENT WETLAND RESTORATION PROGRAM (WRP)
DWQ Project No.
APPROVAL DATE:
LOCATION:
COUNTY:
BASIN/SUBBASIN:
STREAM INDEX NO.:
03-1479
December 8, 2003
near Whortonsville
Pamlico
03-04-10
27-141-1 & 27-141
As required by 15A NCAC 2B .0233 and the conditions of the variance approval, you are required to compensate
for the above impacts through the restoration or enhancement of buffers as outlined below prior to conducting any
activities that impact or degrade the waters of the state.
319 square feet of riparian buffers
One of the options you have available to satisfy the compensatory mitigation requirements is through the payment
of a fee to the Riparian Buffer Restoration Fund per 15A NCAC 213 .02421. If you choose this option, please sign this form
and mail it to the WRP at the address listed below. An invoice for the appropriate amount of payment will be sent to you
upon receipt of this form. PLEASE NOTE, THE ABOVE IMPACTS ARE NOT AUTHORIZED UNTIL YOU HAVE
RECEIVED NOTIFICATION THAT YOUR PAYMENT HAS BEEN PROCESSED BY THE WRP.
Signature
Date
WETLANDS RESTORATION PROGRAM (WRP)
NC DIVISION OF WATER QUALITY
1619 Mail Service Center
Raleigh, NC 27699-1619
(919) 733-5208
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
imap://bob.zarzecki %40dwq.denr. ncmail. net @ cros.ncmail.net:143/fe...
- N)* ??Ov?u
,-. -,4
L , a-L 'No - w -
owi
ncmail.net>
iail.net>
know its status and said they sent it in Oct
Filemaker, I had them fax me a copy of the
a site visit and wanted to let you know it
1337) previous septic permits where issued in
How do we want to procede from here on the
Any new developments in your family?? When is the due date?
A word of advise- sleep! Get it while you can now, because you may not get
much of it for a while after the baby is born. Talk to you soon.
Sincerely,
Stephen
Bob Zarzecki wrote:
031479 - Christopher Rockwell - Pamlico County... it came thru triage
this week... it was dated received on November 21st...it was recommended
to be issued...I plan to write it soon...
Cyndi Karoly wrote:
Stephen - of that laundry list of files you called about:
I can find no records under Jerry or Christopher Walker/Walkwell or Fork
Point Subdivision Lot 10, no matter how I combine the above names.
Supposedly a minor variance request. Bob and Mike - have you heard of
this file?
I'm finding no Mike Marr - Mike, heard of this one?
Jan Shank is 03-1298 in Craven (not Pamlico) County. We're showing a
reed date of 10/22/03, but no evidence it was triaged from there. Is
it a CAMA app, or do you even know? Mike - any idea what's up with this
application?
John P. Herman, Pamlico Co., 03-1091 - This is also a Minor Variance
request, currently on hold. The latest info in the file is from Mr.
Herman - a letter dated 9/23/03, in which he's requesting an extension
to provide the info we requested in our 9/11/03 hold letter. To date,
we have received no add'1 info from Mr. Herman - such as a map, plot
plans, lot info and photos as requested. I'm putting it back in the
hold drawer. Tom Steffens was copied on our hold letter, but I'll fax a
copy now to your attention along with Herman's letter.
1 of 1 12/7/2003 10:13 AM
FRECEIVED
OCT 2 7 2003
Letter of Transmittal 08 14 7 6WQ-WARO
W A L K fR
GROUP
dRfNITEfTURf
incorporafed
PO BOX 541, NEW BERN, NC 28563
233 Middle St. Suite 105, New Bem, NC 28563
252-636778. FAX 252-636-8942
walkergroupQearth Iink.net
To:
State of NC
D. E. N. R.
Div. of Water Quality
Tom Stephens
943 Washington Square Mall
Washington, NC 27889
We are sending you the foil ini 1:
Shop Drawings Prints
Copy of Letter Specs
Change Order Plans
Date: 10/24/03 Proj. No.: 0110ROK
Attention:
RE: Variance Request Form
ID#:
Samples
Payment Application
X Other
Copies Date No. Description
1 10/24/03 (1 Variance Request Form - for Minor Variances
1 appreciate all the direction you have provided. Please call with
an questions or concerns. Thank you.
WETLANDS 1401 GROUP
03
These items are transmitted as checked below:
x For Approval Reviewed WATER QUALM SECM
For Your Use Reviewed as Noted
As Requested Revise & Resubmit
For Review and Comment Returned No Action
Prints returned after Loan to us
Remarks:
Co ies:
X Architect ri Owner
Engineer: Other.
Contractor. Other. /
Signed:
Wry L. alker, A.I.A.
\\G2400\data\WG Master File Structure\Projects\2001 \01 10 Rockwell Residence\Correspondence\Transmittals\102403VarRegDENR.doc
.y
OFFICE USE ONLY: Date Received '- Request #
10
State of North Carolina OCT 2 7 2???
Department of Environment and Natural Resources
Division of Water Quality
`VVQ-WARD
Variance Request Form - for Minor Variances
Protection and Maintenance of Riparian Areas Rules
NOTE. This form may he photocopied for use as an original.
Please identify which Riparian Area Protection Rule applies.
p( Neuse River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC.0233)
? Tar-Pamlico River Basin: Nutrient Sensitive Waters Management,
Strategy Protection and Maintenance of Riparian Areas Rule (15A
NCAC.0259)
rari i. %36 tv&Fal Iii lVilila LiG;I
(Please include attachments if the room provided is insufficient.)
1. Applicant's name (the corporation, individual, etc. who owns the property):
2.
Print Owner/Signing
Name:
Title:
Street address:
City, State, Zip:
Telephone:
Fax:
(person legally responsible for the property and its compliance)
3. Contact person who can answer questions about the proposed project:
Name: J SMY t, ytAt rJaR,
Telephone: ZSZ} <*34o'8778
Fax: (ZSZ.} !o - 42
Email: Wla(.kera vrov(a ?- Ca v' +k It 11 14- . Corp _
4. Project Name (Subdivision, facility, or establishment name - consistent with project name on
plans, specifications letters, operation and maintenance agreements, etc.):
5. Project Location:
Street address: Lcrr t o it to FDW. Tby 1- ' -V-OAx>
City, State, Zip:
County: -RdMUCO e-outl-rIl`( CLz-F4 C4F_UA1,GQ.
Version 1: February 2000
Latitude/longitude:
6. Directions to site from nearest major intersection (Also, attach an 8'/z x 11 copy of the USGS
topographic map indicating the location of the site):
7. Stream to be impacted by the proposed activity:
Stream name (for unnamed streams label as "UT" to the nearest named stream):
Sµ1P ceEEK / 1*raA,>o GR.Gea-.
Stream classification as identified within the Schedule of Classifications 15A NCAC. 2B .0315
(Neese) or.0316 (Tar-Pamlico)]:
8. Which of the following permits/approvals will be required or have been received already for
this project?
Required: Received: Date received
_k",
Permit Type:
CAMA Major
CAMA Minor
401 Certification/404 Permit
On-site Wastewater Permit
NPDES Permit (including stormwater)
Non-discharge Permit
Water Supply Watershed Variance
Others (specify)
Part Z: Proposed Activity
(Please include attachments if the room provided is insufficient.)
Description of proposed activity [Also, please attach a map of sufficient detail (such as a plat
map or site plan) to accurately delineate the boundaries of the land to be utilized in carrying
out the activity, the location and dimension of any disturbance in the riparian buffers
associated with the activity, and the extent of riparian buffers on the land. Include the area
of buffer impact in fe.: HIGO
2. State reasons why this plan for the proposed activity cannot be practically accomplished,
reduced or reconfigured to better minimize or eliminate disturbance to the riparian buffers:
5E-7-cct'kGa.tO
3. Description of any best management practices to be used to control impacts associated with
the proposed activity (i.e., control of runoff from impervious surfaces to provide diffuse flow,
re-planting vegetation or enhancement of existing vegetation, etc.):
5sL ACTT 10
Variance Request Form, page 2.
Version 1: February 2000
JtA 'Dtr2T 9_0AA0 sE.F_
.V
4. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this
Rule.
SEE Ae-T ACefK
(2) How these difficulties or hardships result from conditions that are unique to the property
involved.
C-- Ax-r k," lyb
(3) If economic hardship is the major consideration, then include a specific explanation of the
economic hardships and the proportion of the hardship to the entire value of the project.
Part 3: Deed Restrictions
By your signature in Part 5 of this application, you certify that all structural stormwater best
management practices required by this variance shall be located in recorded stormwater
easements, that the easements will run with the land, that the easements cannot be changed or
deleted without concurrence from the State, and that the easements will be recorded prior to the
sale of any lot.
Part 4: Agent Authorization
if you wish to designate submittal authority to another individual or firm so that they may provide
information on your behalf, please complete this section:
Designated agent (indiN
Mailing address:
City, State, Zip:
Telephone:
Fax:
Email:
4LT = XO
Part ,a5: Applicant's Certification
it S 2ocle ? fir- z- (print or type name of person listed
in Part I, Item 2), certify that the information included on this permit application form is correct,
that the project will be constructed in conformance with the approved plans and that the deed
restrictions in accordance with Part 5 of this form will be recorded with all required permit
conditions.
Signature:
Date:
Title:
Variance Request Form, page 3
Version 1: February 2000
Part 2: Proposed Activity (continuation)
Description of proposed activity.
We are proposing to build a single family dwelling on the site. (See attached CAMA
Delineation Plat)
2. State reasons why this plan for the proposed activity cannot be practically accomplished,
reduced or reconfigured to better minimize or eliminate disturbance to the riparian buffers.
As can be seen from the CAMA Delineation Plat, the site has an irregular shape, i.e. very
narrow at the North end and much wider at the South end. There is also an existing septic
tank and drain field located at the approximate middle of the property. It would be our
preference to locate the house structure near the septic tank to achieve the proper drop in
order to provide the necessary gravity flow to the septic tank. We originally sited the house
structure near the middle of the widest portion of the site, but still close to the septic tank. An
original survey (see attached) shows the marsh at the Southeast corner of the property to be
adjacent to the property but not on the property. As originally planned, a 50-foot zone 1 and
zone 2 buffer was measured from the indicated marsh line and the structure was located
within the remaining area of the property without extending into the buffer zone. As we later
discovered, the marsh actually encroaches on the property so we have moved the house
structure to the Southwest all the way to the 10-foot setback as well as rotated the house
structure counterclockwise. This action eases the encroachment considerably, but there is
still a structure encroachment in Zone 2. As can be seen from the CAMA Delineation Plat the
house structure enters Zone 2 and covers 57 square foot of area. Also, a composite material
overhead deck covers 156 square feet. The deck is pervious and does allow water to pass
thru. We feel that the remaining portion of the property, not in Zone 1 or Zone 2, does not
allow enough square footage to acceptably place a house structure. It virtually divides the
property in half. We feel that by encroaching into Zone 2 by a minimal amount we can
achieve a reasonable house structure location as well as a minimal impact upon the site. It
should be noted that the foundation for the proposed house are driven wooden piles with a
raised floor deck, approximately 10'-0" above finished grade. A perimeter deck (a composite
material, 'Trex") will surround the house structure. The deck is approximately 10'-0" above
finish grade and allows water to drain between boards. This will provide the structural
integrity necessary, but more importantly, the pile foundation will minimize the impact upon
the site and cause the least disturbance.
3. Description of any best management practices to be used to control impacts associated
with the proposed activity.
As Zone 2 is affected by the pile foundation as well as the overhead pervious deck, great care
shall be taken to maintain existing vegetation as well as to replant an area equivalent to the
area affected in Zone 2. Once again, it should be noted that the impact in Zone 2 is only the
\\G2400\data\WG Master File Structure\Projects\200 1\0 110 Rockwell
Residence\Correspondence\Letters\082203 CAMAVariance.doc
driven wooden piles. Only the wood pilings will be in contact with the ground. The finish floor
is approximately 10'-0" above grade as well as the pervious deck.
4.1 Provide an explanation of the following: The practical difficulties or hardships that would
result from the strict application of this rule.
If the strict application of the rule were enforced then the buildable area of the site is greatly
reduced and the siting of the house structure is compromised. Due to the existing septic tank
and drain field and allowing for a reserve or replacement of the septic tank and drain field in
addition to the area occupied by the 50' buffer as well as typical required building setbacks
there is little area remaining to provide for a house structure, a drive from the road, as well as
the necessary siting near the septic tank. We feel that by extending into Zone 2 by 57 square
feet of house structure and 156 square feet of permeable deck area or approximately 3% of
the buffer is minimal and acceptable as compared to the practical difficulties involved in trying
to achieve the necessary siting issues as mentioned above. Once again only the wooden
piles are in contact with the ground as any other finish floor or deck are approximately 10'-0"
above final grade.
4.2 How do these difficulties or hardships result from conditions that are unique to the
property involved?
The practical difficulties and hardships as mentioned above are largely due to the unique
shape of the site and the location of the existing septic tank and field. The shape of the
property actually allows the house structure to be located in only one area of the property, the
southern half. The Southern half is then reduced significantly (by half) by the established
CAMA line.
4.3 If economic hardship is the major consideration, then include a specific explanation of
the economic hardships and the proportion of the hardship to the entire value of the project.
By maintaining a close relationship to the septic tank we are able to control the rate of drop of
the sanitary sewer/septic pipe. If we relocate the house structure we won't be able to
maintain the necessary drop, which will require one of the following. Either a pump station is
employed to deliver sanitary waste to the existing septic tank or the existing septic tank and
drain field are abandoned and reinstalled in another location. Either of these solutions is
costly. We feel the simple solution with the least impact upon the property is to allow the
encroachment into Zone 2 of the overhead finish floor/deck with the wooden piles as the only
contact with the ground.
\\G2400\data\WG Master File Structure\Projects\200 1\0 110 Rockwell
Residence\Correspondence\Letters\082203 CAMAVariance.doc
/ O
_a, / / /
0 216' ? 46?' N 40.0'
20, Q?W .
-4r
I
I O 1
1
c
0
m
0
1o \
Im
1
I
15-
/0?
167
I I? O
Q I EJOSTING NCI 0)
10' EASEMENT
1
1
?- ATLEAST 25' SOLID PIPE
1
1
/ I SEA iC A SUB SURFACE DRAINAGE
MARSH
T/ .4 eL•v.
k
/ . SLAB O
BROAD
CREEK
WALKER
rani is
PREVIOUS SITE PLAN
ROCKWELL RESIDENCE
ORIENTAL, NC
SCALE
AS NOTED
DATE
8/20/03
DRAWN BY
Dc
PR01KT NO
011ONK
DRAWING NO.
(1 .1
N 31?5513"W R ?F
a
26.00• /
P
S 77?5956W
23.19'
10 100, O
10' EASEMENT
00 a w
(00 / / / / 0
oc r
*0
2.9 3.3 I
I 1
'I I
I
/ EXSTNG
/3.3 6 PnC TANK 156 SO. FOOT OF OVERHEAD
sE DECK IN ZONE 2
57 SO, ONE FOOT OF HOUSE STRUCTURE
/ ?VU N
74
W
/ \Z
/ Pl
do c
U
P9
SNIP
CREEK
x.x SPOT ELEVATIONS (BASED ON
WATER LEVEL OF BROAD CREEK,
ASSUMED ELEV. O.O').
L
rnO
0
01 -Na
qa ?
o?
Z
? CAMA DELINEATION PLAT
?JV CIQI5TOPI-IER 20CKWELL
BROAD LOT 10 CAPTW2IGNT
CREEK
SCALE I" = 60'
(WORK PLAT)
WALKER
}GROUP
R ITS TUR
Poasz?ie-ena ?z-au% ns(?)
E pyrIght Omz by TIE YALI?R cRGIR
IREItECTUtE,IRC. All rlgf?te rNerveE.
CAMA DELINEATION PLAT
ROCKWELL RESIDENCE
ORIENTAL, NC
04
SCALE
AS NOTED
DATE
10123/03
DRAWN BY
TJC
PROJECT NO
0110ROK
DRAWING NO.
C1.1
c
i?.
.?
.? ??
.,
_= ???? ;
;?
1: .
,I
c
i
i
Q. O
i
57
nA?
6
0/6 7
1
a
IZI
M ?
Y
. ? ' poT ELENA TJO?S ?8.9SEt7 owo YVf a Q 1 E3?EL O F
RoA L7' C,?2 E?'?C , A L?iYI?!> Fl EJf 4• a ?)
?? z a?
./PAMLICO COUNTY HEALTH DE' AML1CO COUNTY :ALTH DEPARTMENT
BAl :O N c
BAYBORO. N.C.
CERTIFICATE OF COMPLETION
(GROUND ASSO RPTION SEWAGE
DISPOSAL SYSTEM-G.S. CHAP-
TER 130A ARTICLE 11)
OWNER ..............................................................
Location ........
--• .................•-----------.....----....--- S.R. ""
Approved As Shown on Plot Plan ( )
Approved As Shown on Final Plot ( )
IMPROVEMENTS PERMIT#-1-31_
(GROUND ABSORPTION SEWAGE DISPOSAL SYSTEM-G.S. CHAPTER 130A ARTICLE 11)
OWNER-- ;9A!-0r.. U,.._..... _..
Add ress.-&®f111.._D,e.rx-y ??...IZ4-------------- »-.-- S.R. No.
Location _..AAi..t'?9G?.' w ............. _.._.._
.............................................. Lot ........ Blk ........ Sec ...-----
Distance of Well: From Tank ..........................................
From Drainfield ................................
Have Tank and Drain Lines Inspected by a represen-
tative of the Pamlico County Health Department
before covering.
Installed By:
Certificate of Completion By:...................
Date: . .......................................................... ------
'THIS DOES NOT CONSTITUTE A WARRANTY OR GUARANTEE
.....:Ko7z.1...-.1 a1...._...... .............................. S.R. # ......----
Water Supply: Private (x) Public ( ) Mobile Home Park
HOUSE CX) MOBILE HOME ( ) BUSINESS
i
NO. BEDROOMS .............. ..... .......... NO. BATHROOMS ....... I...........
Suitable ( ) Prov. Suitable (>
i
Locate Tank and Lines feet from well: /Aw.....Qr
Size of Septic Tank: `O0,ao. gallons
Nitrification Lines: .--4P.V.. square feet I
-..?.. No. of Lines /Of) Iin. feet
Comments: /?_?...-t...ld .....1.. ."..F ....-7.4 S ..........
uate:..
PLOT PLAN
-C;!? P• - L..
i s \
i
7Ji
1
,e5eY ( X`
....------...._-., z - .--------------------------------------------------------------------
PERMIT VAUD FOR THREE YEARS