IPAC RRHTE#_o~ Harne« County Department of Public Lalth 24517
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
s PROPERTY LOCATION: G e-NE.cz.e,_ IC--C ~T
ISSUED T0: SUBDIVISION LOT #
NEW ❑ REPAIR ❑ E NSION
Type of Structure: 'Mo 9 aA
Proposed Wastewater System Type: s ~T t N C.
Projected Daily flow: 3GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes,No
Site Improvements required prior to Construction Authorization Issuance:
Pump Required: ❑Yes F1.No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community ❑ Public 'K Well Distance from well 5 feet Permit valid for. Five years
Permit conditions: ❑ No expiration
Authorized State Agent:: Date: t 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 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 Building Permit,.)
The construction and installation requirements of Rules .1950, .1952, .1954, .1955, .1956, .1951, .1958. and AM are incorporated by references into this permit and shaft be met. Systems shall be
instilled in accordance with the attached tern layout.
ISSUED T0: PROPERTY LOCATION:
SUBDIVISION
Facility Type: in o o ❑ New A Expansion ❑ Repair
Basement? ❑ Yes 'N, No Basement Fixtures? ❑ Yes "~i No 3 0
Type of Wastewater System" C~ -a s 1. 1-4 C~ (Initial) Wastewater Flow- GPD
(See note below, if applicable
lastailadon RequitrattenAlCondidons
LOT #
Septic Tank Size t OCR gallons Exact length of each trench G 1 TINS feet Trench Spacing: Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover inches
Maximum Trench Depth of: inches (Maximum soil cover shall not exceed
(fren(h bottoms shall be level to +/-1/4" 36" above the trench bottom)
in all directions)
Pump Requirements: ft. TDH vs. GPM inches below pipe
r~ Aggregate Depth: inches above pipe
Conditions: inches total
"If applicable: / andeatand the ryrtem type specified is different from the type specified on the application. / accept the specifications of thin permit.
Owner/Legal Representative Signature: Date:
tms tanstructton a-tnanntson is sugec~ to he st an, plat, or the intended use changes. the Construction Authorization shall not be transferred when there is a change in ownership
of the site. This Construc rization is su to w the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit.
SEE ATTACHED SITE SI(ETCH
Authorized State Agent: Q.S Date:
Const Authorjzation Expiration Date: i a
®N
HTE# 4`1-S-tiG63`] R_ Permit # a~5\ 1
Harnett County Department of hiblic Health
Site Sketch
PROPERTY LOCATON: G~ec.~,t_ 1 E S-r ~
ISSUED TO N ~a sL SUBDIVISION LOT #
Authorized State Agent 'QS W U\,1 KL'-~ OL"~5022' Date: 0
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