IPACAuthorized State Agent:: Date: 'A ~ -~JA-a,, SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuance o e rmits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This
site is subject to revocation if the site plan, plat, or the intended use changes. The Improvement ?mkihall 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
(Required for Buildin Pg ermit)
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.
ISSUED TO: CP-J)N'Z;C-'S ~--K"sa ~ -"l . PROPERTY LOCATION: ~yUQS L SO
SUBDIVISION diI': LOT #
Facility Type: s~=fl UN 1) New ❑ Expansion ❑ Repair
Basement? ❑ Yes "471 No Basement Fixtures? ❑ Yes No
Type of Wastewater System** C,3"--4C X01,4 Ni_ (Initial) Wastewater Flow: 36O GPD
(See note below, if applicable
"--I%-,,1V-k-- (Renair)
Installation Requirements/Conditions
Septic Tank Size I c) O ~i gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
Number of trenches 3
Exact length of each trench $ d feet
Trenches shall be installed on contour at a
Maximum Trench Depth of: inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
Trench Spacing: Feet on Center
Soil Cover: Cinches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
inches below pipe
a, inches above pipe
1 inches total
MATER LINES (INCLUDING IRRIGATIONS ST RE ]OFT. FROM ANY PART F SEPTIC SYSTEM OR REPAIR AREA.
NO UTILITIES ALLOWED IN INITIAL OR REPAIR DRAIN FIELD AREA.
*If applicable: f understand the system type specified is different from the type speciped on the application, l accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
This Construction Authorization is subjec vocation if the site Ian, plat or the intended use changes. The Construction Authorization shall not be transferred when there is a change in ownership of the site. This
Construction Authorization iseYqp compliancA~ visions he Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: \ R s=-s Date: ti l l
ction Authorization Expiration Date: a5
HTE # 12. - 2~ 6~1 Permit # aCt T~0
Harnett County Department of Pub
lie ea, It h
Site Sketch
PROPERTY LOCATON: tJv(~s>^tz„y 'Q~o
ISSUED TO: C- SUBDIVISION ~o sCs .o X~\ LOT
Authorized State Agent: A5 L Yrn T t ,sao~ Date: z {'t 1
i~ UIt
aoEjI
Department of Environment, Health and Natural Resources Sheet:
Division of Environmental Health Property ID:
On-Site Wastewater Section Lot
File
SOIL/SITE EVALUATION Code:
for ON-SITE WASTEWATER SYSTEM
Owner: Applicant:
Address: Date Evaluated:
Proposed Facility: 3 Q q Design Flow (.1949)3 a Property Size:
Location of Site: Property Recorded:
Water Supply: >~Public❑ Individual ❑ Well ❑ Spring ❑ Other
Evaluation Method' :)ZJ---.Au er Boring ❑ Pit ❑ Cut
Type of Wastewater: ewage ❑ Industrial Process ❑ Mixed _TT_
P
R
O
F SOIL MORPHOLOGY OTHER
I 1940 .1941 nn~crr n
E
#
ape n sc
Position)
Slope %
Horizon
Depth
(In.)
~'UA
1941
Structure/
Texture
G '3
.1941
Consistence
Mineralo
~(S 1 t~15 ~1~1Q
.1942
Soil
Wetness/
Color
1943
D Sh1IN.
1956
Class
.1944 Profile
Restr Class
Horiz & LTAR
Description Initial Rep it System Other Factors (.1946):
S st Site Classification (.1948): f
Available Space. 1945) Evaluated By:eK>
System T e(s) Ge r f Others Present: p tr
Site LTAR