IPAC - SEE NOTES IN HTE BEFORE ISSUING PERMITHTE#o'1- Harnett County Department of Public Health 2 5 6 7 9
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: c") SrlaoyrE
ISSUED TO: Y F- '16 VU-pc,--'e- by1LUE(L`~~IvG SUBDIVISION Q\>~\L ~aLtp~,
LOT #
NEW ❑ REPAIR ❑ EXPANSION Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: SV-D Poo~~~oN
Proposed Wastewater System Type: Ca--4 ~ d ~ v t
Projected Daily Flow: LA % O GPD <o<o _
Number of bedrooms: LA Number of Occupants: max
Basement ❑Yes <No
Pump Required: ❑Yes No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community b Public X Well Distance from well feet Permit valid for: Five years
Permit conditions: L P„so \,)-3q ReQ L.c G C\ s t ,tE P.~ eta 'T'o P t ~~az C~u,r. Z ❑ No expiration
(~>c ~rcAQACarn~S PECt\SLVJS\Ocr r,! '\~u on,t_Z_~,r~_ o. ~1 i~9
Authorized State Agent.: v.NS Date: q~~ ~ 6 ~ SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees ante of other permits. The permit holder is resp 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 mprovemem Permit 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, J957, .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 l
ISSUED T0: ~~~K~ guLtoC_~C- ~~\LOE2s 1NC PROPERTY LOCATION: SttAS C`~oo~
SUBDIVISION Q uA'\,-- LOT # 1-5
Facility Type: ❑ New Expansion ❑ Repair
Basement? ❑ Yes -'2 No Basement Fixtures? ❑ Yes '1,~( No
Type of Wastewater System** C--A -z-- 0Ktu.i, (Initial) Wastewater Flow: C)GPD
(See note below, if applicable
~)~/o ?'SZ VGSC\tlN
Installation Requirements/Conditions
Septic Tank Size Exis s gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
pair)
Number of trenches I
Exact length of each trench
Trenches shall be installed on contour at a
Maximum Trench Depth of. a) 1
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
feet Trench Spacing: Feet on (enter
Soil (over: Ia inches
inches (Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
Conditions: I-x Hp- Musk ~
l rr15 n~ pb- C)(L
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 aubject t revocation if the site plan, plat, or the intended use chanties. The Construction Authorization shall nnr hp trandnrrnd when thorn it , A- , „W„-ki of A Tki,
(onstruction Authorzation is subject to compliant¢ wtt - raviuQns 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: I d
*istruction Authorization Expiration Date: `t~
HTE# a5 _ 6-~ Permit # ~ 5
Harnett County I)epailment of lliiblic Health
site ketch
~j PROPERTY LOCATON: S) ~ eaR
ISSUED TO: Y-Z'rW, D6\j to r--0j 1 *j C, SUBDIVISION t v Da L ~a U- i LOT #
Authorized State Agent: ZG--AS 6-V\3M -TOu~saoR~ Date:
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