IPACHTE# /Z arnett County Department of Public Health
Imarovement Permit 27140
A building permit cannot be issued with only an Improvement Permit pp
_ oo PROPERTY LOCATION: Po ^ck Q�X CA
�z-✓ - A'
ISSUED T0: J a �c1 !�- = C �G� �lJ�ia� SUBDIVISION LOT #
NEW 5k' REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: Y'vV el 14 7% 1C i q
Proposed Wastewater System Type: aT7- / -c3L 4-' �! f$r-
Projected Daily Flow: 3 Q GPD
Number of bedrooms: 3 Number of Occupants: max
Basement []Yes NK0
Pump Required: ❑Yes 2 No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community C�ublic ❑ Well Distance from well feet Permit valid for: P Tive years
Permit conditions: ❑ No expiration
Authorized State Agent:: m• . Date: ,'LQJ -L SEE ATTACHED SITE SKETCH
The issuance of this permit a Health Department in no way guarantees the issuance of 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 Permio
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. D
ISSUED T0: r �; c�� fog PROPERTY LOCATION: Jon a e r oro. lei
SUBDIVISION 6'ol LOT # V
Facility Type: S-�J /ft New ❑ Expansion ❑ Repair
Basement? ❑ Yes Q"No Basement Fixtures ❑ Yes ❑ No
Type of Wastewater System ** Oi-/. ,��ve. en �/�e.� (Initial) Wastewater Flow: X66 GPD
(See note below, if applicable ❑)
cZ f_(` ke4 -%:P —=f_ 4 (Repair)
Installation Requirements /Conditions Number of trenches 17-
Septic Tank Size /00t gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
Exact length of each trench 7 S'_ feet
Trenches shall be installed on contour at a
Maximum Trench Depth of, 311. - / inches
(Trench bottoms shall be level to +/ -1/4"
in all directions)
GPM
Trench Spacing: ci Feet on Center
Soil Cover: 2, y inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
inches below pipe
Aggregate Depth: inches above pipe
inches total
WATER LINES (IN(LUDING 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: I understand the system type specified is different from the type specified ofl the application. / accept the specifications of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorization is subject to revocation if the site plan, 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 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: c�:. Date: u z' X-0 / 2
Construction Authorization Expiration Date: I v A Y,A v
I
:D roo k I J-)-,;,, - '�)
Department of Environment, Health and Natural Resources
Division of Environmental Health
On -Site Wastewater Section
SOIL /SITE EVALUATION
for ON -SITE WASTEWATER SYSTEM
Owner: Applicant:
Address: Date Evaluated: AD
Proposed Facility: Design Flow (.1949):
Location of Site: Property Recorded:
Water Supply: ["Public❑ Individual ❑ Well
Evaluation Method: ger Au Bort g ❑ Pit ❑ Cut
Type of Wastewater: Sewage ❑ Industrial Process
Sheet:
Property ID:
Lot #:
File #:
Code:
Property Size:
❑ Spring
❑ Mixed
❑ Other
P
R
O
F
I
L
E
#
.1940
Landscape
Position/
Slope %
Horizon
Depth
(In.)
SOIL MORPHOLOGY
.1941
OTHER
-PROFILE FACTORS
Profile
Class
& LTAR
.1941
Structure/
Texture
.1941
Consistence
Mineralogy
.1942
Soil
Wetness/
Color
.1943
Soil
Depth (IN.)
.1956
Sapro
Class
.1944
Restr
Horiz
Description
Initial
Sys tem
Repair System
Other Factors (.1946):
Site Classification (.1948):-5-
Evaluated By: ,6 -
Others Present:
Available Space(. 1945
System Type(s)
0\_f—r'
a S' 71n
Site LTAR
8