IPAC RHTE# HarneL( County Department of Public health
Imarovement Permit 2691 2
A building permit cannot be issued with only an Improvement Permit
~J p / PROPERTY LOCATION: l1M 6-, GroVc R
ISSUED T; lW c~ 1"Ly~SUBDIVISION LOT # 02.E
NEW 19' REPAIR ❑ EXPANSION ❑ , Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: 57F D 1 ` C1-~
Proposed Wastewater System Type:
5'Y~
Projected Daily Flow: L/$0416WTOGPD
Number of bedrooms: y Number of Occupants: 8 max
Basement ❑Yes RNo
Pump Required: ❑Yes LEI No ❑ May be required ~sed on final location and elevations of facilities
Type of Water Supply: ❑ Community ❑ Public Y Well Distance from well feet Permit valid for. 21 Five years
Permit conditions: ❑ No expiration
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Authorized State Agent:: ~.r' ~ _ Date: 3 /r °l Z- Z r 20t"AE ATTACHED SITE SKETCH
The issuance of this permit by A Healt~in no way guarantees the issuance of other permits. The permit holder is responsible for checking with ppropriate governing bodies in meeting their requirements. This
site is subject to revocation if the site plan, plat, or the intended use changes. The Improvement Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of
the Laws and Rules for Sewage Treatment and Disposal and to conditions of this permit..
Construction Authorization
Reauired for Building Permit
The construction and installation requirements of Rules .1950, .1952, .1954, .1955, .1956, .1957, .1958. and .1959 are incorporated by references into this permit and shall be met. Systems shall be installed in accordance
with the attached system layout.
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ISSUED TO: '10~/t+ed k T~ 1. y t0. M)/ PROPERTY LOCATION: 4
SUBDIVISION LOT # o2_
Facility Type: New ❑ Expansion ❑ Repair
Basement? ❑ Yes ❑ No Basement Fixtures? ❑ Yes ❑ No
Type of Wastewater System'`* oZ5_Y~ S fr4^- (Initial) Wastewater Flow: S$ d GPD
(See note below, if applicable
f , LJ v'G ~ .ryJ•~ (Repair)
Installation Requirements/Conditions Number of trenches ,.5
Septic Tank Size 1-1,5-0 gallons Exact length of each trench 80 feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of: /8 - c2-a2 inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
Conditions: -S-4,1-_' 8 . -Fc- ker f & . ^c-ke r
Trench Spacing: Feet on Center
Soil Cover: 6- r d inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
inches below pipe
Aggregate Depth: inches above pipe
inches total
WATER LINES (INCLUDING IRRIGATION) MUST BE LOFT. FROM ANY PART OF SEPTIC SYSTEM OR REPAIR AREA.
NO UTILITIES ALLOWED IN INITIAL OR REPAIR DRAIN FIELD AREA.
**If applicable: /understand the system type specifed is different from the type specified on the application. / accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
this Lonstruction Authorization is subject to revocation it the site plan, plat, or the intended use changes. the Lonstructon Authorization shall not be translerred when there is a change in ownership of the site. This
Construction Authorization is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: Z~' t -
- '`-Date:
Construction Authorization Expiration Date: 3 ~°r7 ~3Q~2v/-7
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