ETHTE# O ~---O - D 1(~, g 1
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME C C~~ _ 1 c[~ ► PHONE # -
ADDRESS 1 In r f
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) )A
I I
PROPERTY LOCATION: STATE ROAD NAME AND # C"(- 11
~c
PURPOSE OF INSPECTION.
The aforementioned site has been evaTu-at-gdl-y-ths-TFar-n-eft-C-0-u-nTy-He--afth Department
Environmental Health Section. At the time of Inspectlom there appeared to be a septic
system serving this site. If this system should malfunction, the owner Is responsible for
any necessary repairs.
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or
(2) the system should fail or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
A~) Z2-7,V
Sigma re of Environmen al Health Specialist Date
HTE# (01L Harnett County Department of Public Health
Improvement Permit
A building permit cannot be issued with only ary Improvement Permit
PROPERTY LOCATION: 1 1 ~ ~
ISSUED T0: fit' t°r 1~-(d`'(L f SUBDIVISION
LOT #
NEW ❑ REPAIR ~R- EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: F)( k. a-- tV
~ CFl"
Proposed Wastewater System Type:
Projected Daily Flow:
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: Ltj Community ❑ Public ❑ Well Distance from well [_10 feet Permit valid for
Permit con itions: r at h kz- A, Me L.,1 d /tlz L> r, IN _ /1,1 - W % S3 , ~l,1 1`e I IL ❑ Five years
❑ No expiration
Authorized State Agent:: C L- I(l_~ _ Date: OD- J)-D ~ SEE ATTACHED SITE SKETCH
The issuance of this permit by the H th 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 these 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:(I>,~u• cl t~ PROPERTY LOCATION:
Facility Type: Z x c , -C' s
Basement? ❑ Yes ❑ No
Type of Wastewater System** _
(See note below, if applicable
Installation Requirements/Conditions
Septic Tank Size fJ.7 gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
(Repair)
Number of trenches
Exact length of each trench
Trenches shall be installed on contour at a
Maximum Trench Depth of
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
Aggregate Depth:
inches below pipe
inches above pipe
inches total
**If applicable: / understand the system type specified is different from the type specified on the app/ication. / accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
is lulistr1U1011 ALIUMicahm1 is suufect to revocation it me site plan, plat, or the mtenaed use changes. the tonstruchon Authorization shall not be transferred when there is a change in ownership of the site. This
construction Authorization is suDfect to
Authorized State Agent:
Date: 1) ) 01
Construction Authorization Expiration Date: 0'3- D`1- ~2 ~
S f, SUBDIVISION
❑ New ❑ Expansion -J~;' Repair
Basement fixtures? ❑ Yes ❑ No
with the provisions of the laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit Stt Al IALHED SITE SKEILH
25364
LOT #
(Initial) Wastewater Flow: GPD
feet Trench Spacing: Feet on Center
Soil Cover: inches
inches (Maximum soil cover shall not exceed
36" above the trench bottom)