IPAC RHTE# 2 5-9~~ 0CA 1R, ari,,,ct County Department of Public eaealth
Improvement Permit 27068
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: ii~>UI✓ NP~WI<-~*1S
ISSUED T0: p.Mdi14~, ~c. T^Oy ~2`S ~S SUBDIVISION C`czEl=c~r?,N G~@.> LOT #
NEWX REPAIR ❑ XPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: SF9 ACC h5l`
-S%Jflyc~~~~v Sys :1rsn
Proposed Wastewater System Type:
Projected Daily Flow: 3E, D GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes No
Pump Required: ❑Yes No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well lbo~) feet Permit valid for: Five years
Permit conditions:„ ❑ No expiration
Authorized State Agent:: `i► Y~ "N3 Date: SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issu other permits. 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 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
(Required for Building Permit)
The construction and installation requirements of Rules .1950, .1952, .1954, .1955, .1956, .1951, .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 T0: PROPERTY LOCATION: Q vo \f ?P-M*W;Z)
SUBDIVISION `=2eVin>,.J C-Nn,aC,E LOT #
Facility Type: S QD C,~'xs T New ❑ Expansion ❑ Repair
Basement? ❑ Yes ]~k No Basement Fixtures? ❑ Yes ~No
Type of Wastewater System" QZ:Ne ~-GUV~S\b N SiG 1r1 (Initial) Wastewater Flow: GPD
(See note below, if applicable
°/o QCDyG1c1-%J Sys) E;n (Repair)
Installation Requirements/Conditions Number of trenches I
Septic Tank Size 1 C O(Z) gallons Exact length of each trench `ate feet Trench Spacing: Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: G-10 inches
Maximum Trench Depth of: 111-a inches (Maximum soil cover shall not exceed
(Trench bottoms shall be level to +/-1/4" 36" above the trench bottom)
in all directions)
Pump Requirements: ft. TDH vs. GPM inches below pipe
Aggregate Depth: inches above pipe
Conditions: 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 speciped is different from the type speciTed on the application. / accept the specipcations of this permit.
Owner/Legal Representativ re: Date:
This Construction Authorization is subject to revoc o
n i Ian, t or the intended use changes. The Construction Authorization shall not be transferred when there is a change in ownership of the site. This
911
Construction Authorization is subimpliance wit rovis a and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: Dater`
- -13 I ZI ~t. Construct) uthorization Expiration Date: 6
HTE# Ng--5- p
Permit # WX)~R
H(arnett County Department of Public et,dth
Site sketch
PROPERTY LO(ATON: pizUfl ~~PsWX lr.}~ ~.9
ISSUED T0: Nlc~5 SUBDIVISION c-,lPia .-ID.NCE LOT #
Authorized State Agent: 6,)-4C(L ' ~OL`F~Sfl4 Date: la`111~
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