IPACHTE#_09 - qol Harnett County Department of Public Health 2 4 4 9 4
Improvement Permit
A building permit cannot be issued with only an Im rovement Permit
PROPERTY LOCATION: I a `j
ISSUED T0: rl~n~f~ SUBDIVISION ~A (Y\(YActi t ` LOT # a1_
NEW)4 REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: _500 - L„to , 3'3 (L-
Proposed Wastewater System Type: a~ ~~_f~~
Projected Daily flow: 3(O GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes 19 No
Pump Required: ❑Yes ❑ No ~i0ay be required based on final location and elevations of facilities
Type of Water Suppl : ❑ Community 5Z Public ❑ Well Distance from well C J feet Permit valid for X Five years
Permit conditions: Q)t,f,~,l-vsyv sl-~AII~v %I C12 A-, ❑ No expiration
Authorized State Agent:: _ Date: SEE ATTACHED SITE SKETCH
The issuance of this permit by tho(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 is subject to revocation it 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 taws and Rules for Sewage Treatment and Disposal and to conditions of this permit.
Construction Authorization
Re uired for Building Permit
The construction and installation requirements of Rules .1950. .1952, 3954, 1955, .1956, .1957, Alis& 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: kc nr1-C n A I V IC, LOCATION: 2 2
SUBDIVISION _f_t4M/n.tlz- h - ) ( LOT #-2
2
facility Type: x fZ New ❑ Expansion ❑ Repair
Basement? ❑ Yes ~a No Basement Fixtures? ❑ Yes -9 No
Type of Wastewater System" 21I IL J, A,.,, (Initial) Wastewater Flow: 1L _j- GPD
(See note below, if applicable
1) ^
(Repair)
InsUbtion Nnuirementt/Conditions
Septic Tank Size gallons
Pump Tank Size gallons
Pump Requirements: IL TDH vs.
Conditions:
Exact length of each trench ( J feet
Trenches shall be installed on contour at a
Maximum Trench Depth of: _ '-f inches
(Trench bottoms shall be level to +1-114"
in all directions)
GPM
Trench Spacing: Feet on Center
Soil Cover. inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
inches below pipe
inches above pipe
inches total
**If applicable /understand the ty tem type .rpecifted it different from the type rpecifled on the application. l accept the (pec1lcat1onr of this permit.
Owner/Legal Representative Signature: Date:
This Construction Authorization is subject to revocation d the site plan, plat, or the intended use changes. The Construction Authorization shall not be transferred when there is a change in owners hip
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
Authorized State Agent. Date: 0K SEE ATTACHED SITE SKETCH
Construction Authorization Expiration Date: Q 2 - d C - d313
NTE# Permit #P211 Y5 L(
Rarnett, County Department of hiblis Health
Site Sketch
PROPERTY LOCATON: 2 2 5
ISSUED TO: n n ~u (Y1I+ t h _ SUBDIVISION V?l Ir r LOT # _
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Authorized State Agent:
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