IPACHTE# Q' ► -s~ Harnett County Department of Public Health 2 5 5 5 4
hDrovement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: L r-_-QCg_ t-o c ~c
ISSUED T0: k-~~t+G~H 6s SUBDIVISION \40,3 Na..'. LOT # T
NEW,X REPAIR ❑ PANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: 5 F0
Proposed Wastewater System Type: C o ~t-4 C.•T\ cs ry
Projected Daily Flow: 3 F,d GPD
Number of bedrooms: 3 Number of Occupants: fo max
Basement ❑Yes No
Pump Required: ❑Yes No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well \O feet Permit valid for: Five years
Permit conditions: ❑ No expiration
Authorized State Agent:: c
The issuance of this permit by the Health Department in no way guarantees the issuance
site is subject to revocation if the site plan, plat, or the intended use changes. The Improvement
the Laws and Rules for Sewage Treatment and Disposal and to conditions of this permit..
Date: I `1 101 SEE ATTACHED SITE SKETCH
s. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This
shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of
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
ISSUED TO: cumc•,\r, r-5 PROPERTY LOCATION: L-Ex,y6.3- ~ti-Ac~c
SFOCC7 ~A-8"AD SUBDIVISION Wadosxscz~ LOT # 1' 1
facility Type: X New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ YesNo
Type of Wastewater System** Clo rr V e-r~ "Q) N Dtil_ (Initial) Wastewater Flow: 34 b GPD
(See note below, if applicable
N ewTIM Urv>IL (Repair)
Installation Requirements/Conditions Number of trenches
Septic Tank Size to In U gallons Exact length of each trench 53t7 feet Trench Spacing: c1 Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: 1x-14 inches
Maximum Trench Depth of. akl i 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 L inches below pipe
Conditions:
Aggregate Depth:
inches above pipe
inches total
**If applicable: /under Land the system type specified is di/ferent from the type specified on the app/ication, /accept the specifications of thi permit.
Owner/legal Representative Signature: Date:
This Construction Authorization is subject to revoca 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 subje complian~ tl pro o Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State Agent:
1.~5 Date:
Authorization Expiration Date:
HTE# O"1-5--D3C n Permit # 1-
Harnett Connty DepaAment of l'Vblic Health
Site Sketch
PROPERTY LO(ATON: E-EMV~L ~i-AC.x C~
ISSUED TO: 5s" ~cY. '~1GS SUBDIVISION \A-3ov %(L LOT # \-1 K
Authorized State Agent: ~w"SoLxs~ Date:
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Division of Environmental Health
On-site Wastewater Section Property 10:
Lot
File
SOMSITE EVALUATION Code:
for ON-SITE WASTEWATER SYSTEM
Owner: Applicant:
Address: 3
Proposed Facility: Design Flow (.1949):'Z}
Location of Site:
Water Supply: ~>(Pubitc (j Individual [ I Well
Evaluation Method: ~ Auger Boring [ I Pit
Type of Wastewater [ ewage [ I Industrial Process
P
R
o SOIL M
Date Evaluated: X17
Property Size:
Property Recorded:
( I Spring O Other
[ Cut
(J Mixed
ORPHOIL T
OTHER
F
.1941
PROFILE FACTORS
1
.1940
.1842
L
Landscape Horimn
.1841
.1941
,
trod .1943 i 9m
194
E
Position/ Depth
Shv k#W
Consistence
.
we -
Sa
p
R
9
S % (IN.) I
Texture
p
sslc
: i
_
Cola
Ste. ~2 5g N4
1 I tk:,Ze- --4o
I I I I I I I I
Description Initial
'Available Space (.1945)
System Type(s) c> N
Site LTAR
1 Li
75-
. i6
nepair System Other Factors (.1946):
Site Classification(. 1048): P-15
CIO
Evaluated By:
Others Present: