IPAC RHTE# a, Harnett County Department of Public Health 2 4 4 5 6
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION:~ n I2 t ~t IS ~
ISSUED TO: ~t SUBDIVISION _J - T tt~ L LOT #
REPAIR ❑ EXPANSION Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: <t e>c
f _
Proposed Wastewater System Type: am
Projected Daily Flow: o GPD _
Number of bedrooms: ' 4 Number of Occupants: max
Basement ❑Yes 0 No'
Pump Required es ❑ No ❑ May be required based on final location and elevations of facilities
Type of Water Supply. ❑ Community Public /1 ❑ Well Distance from well S--3 feet Permit valid for. 'A Five years
Permit conditions: AM 1~ <J -Z, F- 14,t L, l i, L. Q "7~ { . _ 1 A n u
Authorized State Agent: Date: DI -2 7 - SEE ATTACHED SITE SKETCH
The issuance of this permit 9bye Health Department io 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 is subject 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 Buildinp Pen-nit
The construction and installation requirements of Rules .1950. .1952, .1954, .1955, .1956, .1952, .1958. and .1959 are incorporated by references into this permit and shall be met. Systems shall be
installed in acco ance wi thSj attached stem layout. _
ISSUED TO: C1 ~~✓Y~ C %t PROPERTY LOCATITIION: ' 3 }t~II (72,~t C iz c &
SUBDIVISION Hft l T Dolt c LOT # J-'?
Facility Type: ❑ New Expansion ❑ Repair
Basement? ❑ Yes No Qasef ent Fixtures? ❑ Yes ❑ No
Type of Wastewater System** Ln iv t4. ( (T
I _(initial) Wastewater Flow-
(See note below, if applicable go,
3~S l-F 4- (Repair)
InstaMm RequirenettslCatditions
Septic Tank Size ek gallons
Pump Tank Size QX 111 ~:)z gallons
Pump Requirements: ft. TDH vs.
Conditions:
Exact length of each trench _ feet
Trenches shall be installed on contour at a
Maximum Trench Depth of. ~ inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
GPD
Trench Spacing Feet on Center
Soil Cover. G inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
inches below pipe
Aggregate Depth: inches above pipe
inches total
**If applicable:
l understand the system type specified is different from the type specified on the application. / accept the sped(cations of thin permit.
Owner/legal Representative Signature: Date:
This Construction Authorization is subject to revocation if the site plan, 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 Authorizatio ' 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: w Date: D )-l d, 0 Y
Construction Authorization Expiration Date: 0 1 22 - '9 ' 13
HTE# D~ 1a Permit #
H-ru-nett County I epal 'Ilse it of MIblicHealt h
Site Sketch
_ PROPERTY L0CAT0N: , 3 J- f-,) I ()c~ !2 n c/ L
ISSUED T0: 0-) "1 4A, c rL SUBDIVISION LOT #
Authorized State Agent 6, L-)kQ ) Date: 2-? - ~ K ~TTTT
50 Li (?,-tL. C.~n~Cc
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44
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