IPACHTE# ~i -5-3WO-~. Harnett County Department of Public Health 2 5 4 9 0
Improvement Permit
A building permit cannot be issued with only an Improvement ermit
PROPERTY LOCATION: Ls>.AR~
ISSUED TO: "-)1A Q -45-12v c,-S dC16 ~N C SUBDIVISION Vc Q-0-- s OP,~4 wt~ LOT # V10
NEW'X REPAIR ❑ EX NSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: SEQ S-1 x 3 }
Proposed Wastewater System Type: c„-t a~
Projected Daily Flow: 23 GPD
Number of bedrooms: "3 Number of Occupants: max
Basement ❑Yes 'X No
Pump Required: ❑Yes ❑ No '~R May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 feet Permit valid for Five years
Permit conditions: ❑ No expiration
Authorized State Agent:: A t Date: aka SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuan Cher permits. The permit holder i res nsible 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 Improveme . ermit 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 p
ISSUED TO: ~A *)l) ~ s csz-v~ rC1Ct`~ I~G PROPERTY LOCATION: ~Et'SU L 47LACK
SUBDIVISION Fours, 0~~ LOT # 1DO
Facility Type: 5 \ New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ Yes X No
Type of Wastewater System** G' - L+,,~r \ a N P", (Initial) Wastewater Flow: 0 GPD
(See note below, if applicable
\ o sj D\ (Repair)
Installation Requirements/Conditions Number of trenches 3
Septic Tank Size I dc, 0 gallons Exact length of each trench 50 feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of. 1!J --3 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: -1 inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
~o inches below pipe
inches above pipe
T inches total
**If applicable: / understand the system type specified is different from the type specified on the application. l accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
This Construction Authorization is sublec Lion if the sit n, 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 subject to compliance Ch ns o Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: Date:
Construc on Authorization Expiration Date:
HTE# Permit #
Harnett County Department of M-tblic Health
Site Sketch
ISSUED TO:
Authorized State Agent:
PROPERTY LOCATON: LIE~0-, y( (--I- P) L- V
SUBDIVISION hoc ~ ) NXB LOT #
St LwCg7, OLy-5D2~ Date:
IN,
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Division of Environmental Health
On-site Wastewater Section
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
Owner:
Address: \
Proposed Facility: _j fJ0Qcr%, Design Flow (.1949):
Location of Site:
W
Property ID:
Lot
File
Code:
Applicant:
ater Supply. ~ublic [ J Individual [ ] Well
Evaluation Method: uger Boring [ ]Pit
Type of Wastewater: ICJ Sewage [ ] Industrial Process
Date Evaluated:
Property Size:
Property Recorded:
[ ] Spring [ ] Other
[ ] Cut
[ j Mixed
P
R
o
F
SOIL MORPHOLOGY
.1941
i OTHER
PROFIE5 FACTO
1
L
E
#
.1940
Landscape
Position(.
Slope%'
Horizon
Depth
- (IN.)
1941.
Structure[
Texture
1941
Consistence
Mineral
1942
Soi~ r i.: s ,1943
_ Color Depth; (IN.)
Cf-'MVO
Description
Initial System
Repair System
Available Space (.1945)
V1
.1
System Type(s)
-
C
-
ISIte LTAR
1
7
Q
Other Factors (.1946): -
Site Classification (.1948): S
Evaluated By: CTS
Others Present: