IPACHTE# is - -3 ®33 arnett County Department of Public Health
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
1 �� � PROPERTY LOCATION: ` )o- -(Lxs GLA
ISSUED T0: Ns a�LUGi Q n1 SUBDIVISION 1A51-1'� b zQ LOT # S QL%
NEW. REPAIR ❑ F�(PANSION 13 Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: S�F O Q5 13';N L- " �
Proposed Wastewater System Type: W5 6/b PNIE'00(7,
Projected Daily Flow: GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes '�I!q No
Pump Required: ❑Yes X No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 1 ® feet Permit valid for: Five years
Permit conditions: ❑ No expiration
Authorized State Agent:: Date: N -% 13 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the permits. The permit holder is r ponsible 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 rmit 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..
* *If applicable: /understand the system type rpecifled it different from the type specified on the app lication. /accept the specifications of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorizatmn is revocation if the site plan, plat, or the intended use chances. The Construction Authorization shall not he tranderred when there it a An— is awna "hip at rho tit, Tu„
Construction Authorization is 41K1110 compli trc rovis f the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: `'��� \ �Ca�S Date: t 1s
Con tion Authorization Expiration Date:
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: 5-1
('
PROPERTY LOCATION: Mp"S
` 'd'4L►
SUBDIVISION P\z)) cFocLD LOT # 1�
Facility Type: 9iQ
New ❑ Expansion ❑ Repair
Basement? ❑ Yes -�. No
Basement Fixtures? ❑ Yes No
Type of Wastewater System **
Q.�g'5A PED'JC; "0N Y5-56'a, (Initial) Wastewater Flow: ® GPD
(See note below, if applicable ❑)
"fa 'P'E`Z> VG"51 t) .N 5-Y5 5'[—.SS1 (Repair)
Installation Requirements /Conditions Number of trenches T
Septic Tank Size ees1250
gallons Exact length of each trench feet Trench Spacing: Feet on Center
Pump Tank Size
gallons Trenches shall be installed on contour at a Soil Cover: i inches
Maximum Trench Depth of: Q.' :3® 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:
inches total
* *If applicable: /understand the system type rpecifled it different from the type specified on the app lication. /accept the specifications of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorizatmn is revocation if the site plan, plat, or the intended use chances. The Construction Authorization shall not he tranderred when there it a An— is awna "hip at rho tit, Tu„
Construction Authorization is 41K1110 compli trc rovis f the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: `'��� \ �Ca�S Date: t 1s
Con tion Authorization Expiration Date:
r- - ,
Department of Environment, Health and Natural Resources
Division of Environmental Health
On -Site Wastewater Section
SOIL /SITE EVALUATION
for ON -SITE WASTEWATER SYSTEM
Sheet:
Property ID:
Lot #:
File #:
Code:
Owner: Applicant:
Address: Date Evaluated:
Proposed Facility: i,>� S�0� Design Flow (.1949): Property Size:
Location of Site: Property Recorded:
Water Supply: ublic❑ Individual El Well ❑ Spring ❑ Other
Evaluation Method er Boring ❑Pit ❑ Cut
Type of Wastewater: Sewage ❑ Industrial Process ❑ Mixed
P
R
O
F
1
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
De th (IN.)
—
.1956
Sapro
Class
.1944
Restr
Horiz
1-
{
vFSie cl���P�
S
Description
Initial
S ste
Repair System
Other Factors (.1946):
Site Classification (.1948):
Evaluated By: �l�
Others Present: —
Available Space(. 1945)
System Type(s)
Site LTAR
-_9