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HTE#M-5-~ 3P-V, Q- HarneLi County Department of Public Health 2 4 5 3 8
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: ~WOI
ISSUED T0: 6 1~~ fog \"J, SUBDIVISION _ New LOT # 11-1
NEW, REPAIR ❑ EXP SION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: _ ~~fl " S h~a
Proposed Wastewater System Type: Qu r-19 iEostA Sys
Projected Daily Flow: GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes
Pump Required."$Yes
Type of Water Supply:
Permit conditions:
~I No
❑ No ❑ May be required based on final location and elevations of facilities
❑ Community X Public ❑ Well Distance from well 1C`~ feet
Permit valid for.
I- Five years
❑ No expiration
Authorized State Agenc Date: SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guaran es~ s the issuance of other permits. The rmrt 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, .1 951, .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: g t LLI - Cs Cl,112, :2yc-, 10 "4 l~ PROPERTY LOCATION: LA b5 ~A-
5c, --10 SUBDIVISION T,,-1, LOT # )-1
Facility Type: S~ Ctl:) ~ ✓ ~K New ❑ Expansion ❑ Repair
Basement? ❑ Yes Jk No Basement Fixtures? ❑ Yes %<,No
Type of Wastewater System" Q v rrw--'\ d c-CXR (Initial) Wastewater Flow: ~d GPD
(See note below, if applicable
5--~ ~ (Repair)
InsWation RquirernenWCanditWs
Septic Tank Size l bc7 o gallons Exact length of each trench to feet Trench Spacing: Feet on Center
Pump Tank Size ► O~ gallons Trenches shall be installed on contour at a Soil Cover inches
Maximum Trench Depth of: _ 1'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: t N . o~ t o v CoveokL ~FLS~~J y Rsrv~r GL~ inches total
`*If applicable: / understand the system type speciled is different /rom the type specired on the app/ration. / accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
iRD WO}i(OUIOR RUETIUMaUmi D sugea, revocation me site plan, plat, or the mtenaea use changes. ine Lonstruction Authorization shall not be transferred when there is a change in ownership
of the site. This Construction Au orization uk c lance with the provisions of the laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit.
SEE ATTACHED SITE SUCH
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Authorized State Agent Date: R o
Construction Authorization Expiration Date: 4 p ~~c
NTE# Permit #
Harnett County I epailment of FWAic Health
Site Sketch
PROPERTY LOCATON: 401 ~l -,,-4 y
ISSUED T0: SUBDIVISION "t`v &4v LOT #
Authorized State Agent Date: I~
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