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HTE# (D(o- 3 v2 %..ett County Department of Public Health 2 5 3 5 g
Improvement Permit
A building permit cannot be issued with only an Im rovement Permit
PROPERTY LOCATION: P I
ISSUED TO: A 1' c+z S SUBDIVISION r ( 1 ~t 5 LOT #
NEW, REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: _ Wo - ~ X i - -'s C2 _
Proposed Wastewater System Type: rty 2 - ~r
Projected Daily Flow: ~(n-:', GPD 3 3
Number of bedrooms: 3 Number of Occupants: max
Basement ❑Yes JtNo
Pump Required: j&s ❑ No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community ~ Public ❑ Well Distance from well 0 feet Permit valid for Five years
Permit conditions: (Yhcc f ~~S A;- (7-c- Fl,, A C back L ❑ No expiration
Authorized State Agent.: Date: 0 '-3 - J2 - D 16 - 0J SEE ATTACHED SITE SKETCH
The issuance of this permit by the Heal 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, .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 A_
ISSUED TO: k 1'Ac '`~2) PROPERTY LOCATION: I
c} SUBDIVISION 001 6,-1 q 1 k/ / LOT # _T7
Facility Type: J3Z-,,Z New ❑ Expansion ❑ Repair
Basement? ❑ Yes vQ-No Basement Fixtures? ❑Yes 19L&
Type of Wastewater System** V's^r^~(1 t- n 1 J~ (Initial) Wastewater Flow: O~ GPD
(See note below, if applicable CA-
F1_c ~l &,_I ' (Repair)
Installation Requirements/Conditions Number of trenches
Septic Tank Size 1000 gallons Exact length of each trench feet
Pump Tank Size /0 Do 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 inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
inches below pipe
Aggregate Depth: inches above pipe
inches total
**If applicable: /understand the system type pecified is different from the type specified on the appliwion. /accept the rpecifcatioN of this permit.
Owner/legal Representative Signature: Date:
IIIU WIUI1-1- HUWVrRdMil B =ItLt w revocation n me site plan, plat, or the mtenttea use changes. the Lonstrudmn Authorization shall not be transferred when there is a change in ownership of the site. This
Lonstruchon 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: L t'AA I Date: 0 3- Z
Construction Authorization Expiration Date: o 3- ~2- 20
-24 ?-1 ~~d'31
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Harnett County Department of Public Health
Site ketch
PROPERTY LOCATON: /
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ISSUED T0: SUBDIVISION _obn.i, ( , /1-5' LOT # S
~ok Authorized State Agent: Date:
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