IPACHTE#,/Q- Harnett County Department of Public Health 2 5 81 7
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION:
ISSUED T0:
Y
SUBDIVISION 4LA2 tr V m ~ - e
T-
LOT #
NEW REPAIR ❑
EXPANSION ❑
,
Site Improvements required prior to Construction Author
ization Issuance:
Type of Structure: F t 7 X5-7
Proposed Wastewater System Type: Ca:iki
Projected Daily Flow:
GPD
Number of bedrooms:-
Number of Occupants:
max
Basement ❑Yes I No
Pump Required: ❑Yes 12"'No
❑ May be requireddbb ~d on
"Z
e
final location and elevations of facilities
Type of Water Supply: ❑ Community
❑ Public
w
ll
Distance from well feet Permit valid for.
2 Five years
Permit conditions:
❑ No expiration
Authorized State Agent:: E 1 Date: / 2 /Za / a SEE ATTACHED SITE SKETCH
The issuance of this permit the Health epartment 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 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, .1952, .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 T0: r lk r-1e s' 4.. PROPERTY LOCATION: CG ~Ccr Jac
SUBDIVISION Vie- LOT # 5-
Facility Type: F 0 L~1 New ❑ Expansion ❑ Repair
Basement? ❑ Yes R"'No Basement Fixtures? ❑ Yes ❑ No
Type of Wastewater System*" Ca2~re~ r~ (Initial) Wastewater Flow:..-A G GIRD
(See note below, if applicable
C c tioJ e .-,_4 ~ c,, (Repair)
Installation Requirements/Conditions Number of trenches J1
Septic Tank Size /000 gallons Exact length of each trench feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of: a6 inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
Conditions:_brQ: L' .tK_r 4
( Q,- r"'>`r:'C.. r-
Trench Spacing: q Feet on Center
Soil Cover: / inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
inches below pipe
Depth: Z inches above pipe
/ inches total
I **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: C
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 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, V 1 W
Date: l2 - ~l0
Construction Authorization Expiration Date: A-cl
HTE# /4 - J-- ~Zj V Permit # 2, / 7
Harnett County I)epartinent of t-l ablic Health
Site Sketch
PROPERTY LOCATON:CdK ~~ry
ISSUED T0: Ci- koAS i•. a qa SUBDIVISION LOT #
q~ L L
Authorized State Agent: Date: z4Xclo
~z
sl '
kC lfilly ,Ell-
Department of Em mment, Health and Natural Resources Sheaf:
Division of Environmental Health pmpel,ty ID:
On-Site Wastewater Section Lot g:
e.
File
SOIIJSITZ EVALUATION C
o
de:
Co
for ON-SITZ WASTZWATlER SYSTEM
Owner: Applicant:
Address Date Evaluated:
Proposed Facility: Design Flow (.1949): Pmperiy Size:
Location of Site: Property Recorded:
Water Supply: ❑ Public ❑ Individual Well ❑ Spring ❑ Other
Evahmdon Method; Boring 0 Pit cut
Type of Wastewater: Auger e ❑ Industrial Pma~ 8 Nfiw
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O
F
I
.1940
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i
300. MO
.
RPHOLMY
1941
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1941
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.1941
~
1943
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:Iw Hari: • LTAR
FMMM Site clami6catim (.1949X PS
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