IPACHTE# OR-5 Oo- Harnett County Department of Public Health 2 5 2 4 2
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: 5
ISSUED TO: k Y
:2/}1CJ SUBDIVISION ~n s tit LOT # lof
NEWS'-- REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: - - 0-
Proposed Wastewater System Type: RAJ c
Projected Daily Flow: GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes 1Y No
Pump Required: ❑Yes ❑ No -5~ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community ublic ❑ Well Distance from well o feet Permit valid for. 5~r Five years
Permit conditions: T c f 47T r ( 7,1 r, f' At/r 4, 4/( Jr f 6A,- ❑ No expiration
N c, U/l~( l ti I,h4- rr cs .
Authorized State Agent: Date: SEE ATTACHED SITE SKETCH
The issuance of this permit by the 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 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 TO: PROPERTY LOCA ON:
SUBDIVISION Pd 1 0 2H LOT #
facility Type: Sf~t~ S77 X 3S 36(L -,Q New ❑ Expansion ❑ Repair
Basement? ❑ Yes V~_ No Basement Fixtures? 1:1 Yes ;No
Type of Wastewater System** 6, &iwJ . (Initial) Wastewater Flow: GPD
(See note below, if applicable
'Zr LALcX - 5j J~ (Repair)
Installation Requirements/Conditions
Number of trenches'. _
Septic Tank Size JnoJ _ gallons
Exact length of each trench 200 _ feet
Pump Tank Size gallons
Trenches shall be installed on contour at a
Maximum Trench Depth of: 19 inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
Pump Requirements: ft. TDH vs.
GPM
Conditions:
Trench Spacing: Feet on Center
Soil Cover: riches
(Maximum soil cover shall not exceed
36" above the trench bottom)
C- inches below pipe
Aggregate Depth: Z inches above pipe
(Z inches total
**If applicable: / understand the system type specified is different from the type speafled on the app/ication. / accept the rpeafbtions of this permit.
Owner/legal Representative Signature: Date:
ims Lonstrucnon Autnonzaron is subject to revocation it 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: Date: (
Construction Authorization Expiration Date: 0 ? - LTo) y
HTE# S,-\L Permit # 05 d y Z
Ha"llett ('onnty Department of ll~tblic nealth
Site Sketeb
PROPERTY LO(ATON:_ ~1 3 2
ISSUED TO: ` - 7( twi SUBDIVISION fiz),1 (b, . LOT #
Authorized State Agent: 0- Date: 02-
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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: 5ro Design Flow (.1949):
3('7
Property Size:
~
Location of Site: i f )
Property Recorded:
Water Supply: I Public [ J Individual
[ I Well
[ I Spring
Evaluation Method: Auger Boring
[ J Pit
[ I Cut
Type of Wastewater: e w a g e
[ I Industrial
Process
[ ] Mixed
[ I Other
P
R
o
F
SOIL MORPHOLOGY
.1941
OTHER
PROFILE FACTORS
1
L
E,
#
.19417
Landscape
Position/
Slope%
Horiion
Depth .
IN.)
1941
Structure/
Texture
1941
Consistence
Mineralogy
1942
So? - s+
Wetness!
Color
t.=;' 1943:;
Depth (IN:)
1956
Saprtt
Glass
t 1944
Restr:
s Iloriz ,
Profile;
Cfass„
I.TAR
f
'y-~
lr~~
/7,1I
~1f
~
C
I
Description
Initial System
Repair System
Available Space (.1945)
System Type(s)
Site LTAR
~
~
Other Factors (.1946):
Site Classification (.1948)l(2/
Evaluated By:
Others Present: A.J-✓