IPACHarnett County Department
Improvement Permit
A building permit cannot be issued with only anlmprovement Permit
PROPERTY LOCATION:
ISSUED TO: i a 1 INS 5W.,y CP ; c a SUBDIVISION 41 y—m o to ; LOT #
NEW,K REPAIR ❑ ANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: VQ
Proposed Wastewater System T e: `c�5
Projected Daily Flow: LV GPD
Number of bedrooms: 4 Number of Occupants: max
Basement ❑Yes X No
Pump Required: ❑Yes ❑ No XMay be required based on final location and elevations of facilities
Type of Water Su PP ❑� Community � Public ❑ Well Distance from well L ®O feet Permit valid for: Five years
Permit conditions: \ ❑ No expiration
—ems _ � °°
Authorized State Agent: N� 55 Date: ! 14 )3 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the iss�Improveerrmt mits. The permit holder i esponsible far checking with appropriate goaerning bodies in meeting their requirements. This
site is subject to revocation if the site plan, plat, Pr the intended use changes. The 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 pe..
Construction Authorization
(Required for Building Permit
The construction and installation requirements of Rules .1950, .1952..1954, .1955, .1956, .1951, .1956. 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: PROPERTY LOCATION: Q ®c.
SUBDIVISION LOT # -S
Facility Type: AXIA y New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ Yes No
Type of Wastewater System ** ` ��® uc,; ) o N �-Y.5 —� Gx\ (Initial) Wastewater Flow: 4Y® GPD
(See note below, if applicable ❑)
°10 1�kE.D v c-7 , v bi (Repair)
Installation Requirements /Conditions Number of trenches
Septic Tank Size 10 ® c) gallons Exact length of each trench �`� feet
Pump Tank Size fCC,aC."3 allons Trenches shall be installed on contour at a
Ct� rs E� CP 01 Maximum Trench Depth of. 1S 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)
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 application. / accept the specifications of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorization is s o revocation if the 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 ,&0&4 to complia a isio� the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent:
M
Date:
n Authorization Expiration Date:
HTE# Permit # alS 53 3
U rz v I-,
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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:
Proposed Facility: L,.' Design Flow (.1949)Alo
Location of Site: Property Recorded: l
Water Supply: ,NPublic❑ Individual ❑ Well
Evaluation Method:] Auger Boring ❑ Pit ❑ Cut
Type of Wastewater: � Sewage ❑ Industrial Process
Sheet:
Property ID:
Lot #:
File #:
Code:
Property Size:
❑ Spring ❑ Other
❑ Mixed
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
1
L-i
a L;
C
0-A
G sL
vim. )61 Q
su.
NP
3 S
CLo L,c�
"Ye
Description
Initial
Sy
Repair System
Other Factors (.1946):
Site Classification (1948):J&
Evaluated Bye
Others Present:
Available Space (.1945)
System Type(s)
s` v ER
G3
Site LTAR
-