IP ONLYHTE# U1 Harnett County Department of Public Health 2 5 6 5 5
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
_ PROPERTY LOCATION: C-8A u 'Lc -m
ISSUED TO: 1 x'~~^ ~~^m SUBDIVISION LOT #
NEW
REPAIR ❑ EXPANSION ❑
Type of Structure:
Me,, ~Aor--&
Proposed Wastewater
System Type: ~o"rte Asa rs vet
Projected Daily Flow:
GPD
Number of bedrooms:
Number of Occupants: H max
Basement ❑Yes
'~K No
Site Improvements required prior to Construction Authorization Issuance:
Wtr~Lu P~°A~~oa 60 .
Pump Required: ❑Yes ❑ No X 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 conditions:
Five years
❑ No expiration
Authorized State Agent:: ~
The issuance of this permit by the Health Department in no way guaran ees t uance
site is subject to revocation if the site plan, plat or the intended use changes. The Impr
the Laws and Rules for Sewage Treatment and Disposal and to conditions of this permit.
Date: $ ` SEE ATTACHED SITE SKETCH
of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This
vement Permit 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, .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:
Facility Type:
Basement? ❑ Yes ❑ No
Type of Wastewater System*' _
(See note below, if applicable
(Repair)
Installation Requirements/Conditions
Number of trenches
Septic Tank Size gallons
Exact length of each trench
Pump Tank Size gallons
Trenches shall be installed on contour at a
Maximum Trench Depth of:
(Trench bottoms shall be level to -I-/-1/4"
in all directions)
Pump Requirements: ft. TDH vs.
GPM
Conditions:
feet Trench Spacing: Feet on Center
Soil Cover: inches
inches (Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
inches below pipe
inches above pipe
inches total
**If applicable: l understand the system type specified it different from the type specified on the application. l accept the speci6c3tionr of this permit
Owner/Legal Representative Signature: Date:
uM wmu-wri nuuwnLeuun a wuteu to revocaton a me site plan, plat, or the mtenaea use changes. me lonstruction Authorization shall not be transterred when there is a change in ownership of the site. This
Construction Authorization is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State Agent: Date:
Construction Authorization Expiration Date:
❑ New
Basement Fixtures? ❑ Yes
PROPERTY LOCATION:
SUBDIVISION
❑ Expansion ❑
❑ No
Repair
Permit valid for.
(Initial) Wastewater Flow: GPD
LOT #