IPAC RHTE# Har rtt County Department of Public health 2 3 6 7 0
Improvement Permit
A building permit cannot be issued with only an improvement Permit
r- PROPERTY LOCATION:
ISSUED T ..S VC ~ ~ _02(c~s,~ t t z,
SUBDIVISION n -Ii- LOT # V ~
NEW REPAIR ❑ x'42EXPANSION ❑ Site Improvements required prior to Construction Authorization issuance: 19 t-J s p-f
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Type of Structure: S (:D - x 7 a /L E A J,, -A
Proposed Wastewater System Type:
Projected Daily Flow: 3 f.0 GPD
Number of bedrooms: 3 Number of Occupants: --~o__max
Basement ❑Yes ;t?1 No
Pump Required: ❑Yes 1~9-No
Type of Water Supply: ❑ Commt
Permit conditions: Cc
(Y'lA -n ,v. A I l ~f
❑ May be required based on final location and elevations of facilities
5? Public ❑ Well Distance from well S-_ feet
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Permit valid for.
E?f five years
❑ No expiration
Cl'I a-~ Z
Authorized State Agent:: v~ Q -A j2 ( j Date: o -J 7 SEE ATTACHED SITE SKETCH
The issuance of this permit gbyhe Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting
their requirements. This site ubject to revocation if the site plan, plat, or the intended use changes. The Improvement 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, .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: _,S LcVc- Sc iZ- n A.n PROPERTY LOCATION: ~ k Ci''y
SUBDIVISION ` -01 kt h P La-.a-AJ- LOT #
Facility Type: SF - J` S X `~1 New ❑ Expansion ❑ Repair
Basement? ❑ Yes -14 No Basement fixtures? ❑ Yes 9 No
Type of Wastewater System' * L!:y -F > 21•% &t S 'r}, (Initial) Wastewater Flow: ~ GPD
(See note below, if applicable
Instillation RNuirements/Conditions
Septic Tank Size Imo gallons
Pump Tank Size -0 o ..--I gallons
/ yJ
Exact length of each trench feet Trench Spacing: feet on Center
Trenches shall be installed on contour at a Soil Cover. 4 inches
Maximum Trench Depth of: _Lj, A-' 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: /underhand tke syhem type specified is eiNerent /rom the type specified on the application. /accept the specifications al this permit.
Owner/Legal Representative Signature: Date:
TI.:. f__..-....:._ ...i:.
-J- i t.ttun it we Hue prau, pear, or me mtenaea use cnanges. ine tonstructton Authorization shall not be transferred 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: t^ AV (L- C Date: - Cl
Construction Authorization Expiration Date: r cl- X) I Z S 1-k
Lf L ~P (Repair)
HTE#
Harnett County
Permit #
Department of hibl is Health
itp Sketch
i PROPERTY LOCATON: I I
ISSUED T0: ~UC SUBDIVISION Y~ti(t / t-. LOT # J Y
Authorized State Agent: d Date: f 1- 3
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