IPAC RHTE# 1` dl X HarnL County Department of Public ~,alth 23918
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
~PROPERTY LOCATION:
ISSUED TO: SUBDIVISION Qty ~n~~ LOT # Cc,
NEW` REPAIR I] XPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: S i~ D - -
Proposed Wastewater System Type: ._.d si,
Projected Daily Flow: (o GPD
Number of bedrooms: Number of Occupants: (o max
Basement ❑Yes '0 No
Pump Required: ❑Yes 1X, No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ) feet Permit valid for. Five years
Permit conditions: 56a 0 C_ 11,~,f-- El No expiration
Li Vv~ 4- c L' Authorized State Agent: 6 Date: 'l - SEE ATTACHED SITE SKETCH
Date:
The issuance of this permit by a 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 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, .1~2, .t954, .1955, .1956, .1951, .1958. and .1959 are incorporated by references into this permit and shall be met. Systems shall be
installed in accordance with the attacfW syste`~~ IyJout.
ISSUED T0: ~_._{rTt-t r7c) rrzpE ~,rY PROPERTY LOCA ON: 13
SUBDIVISIONq LOT
Facility Type: SCD - LF`{ X 3q .0 e -,)4 New ❑ Expansion ❑ Repair
Basement? ❑ Yes $;d- No Basement Fixtures? El Yes -}No
Type of Wastewater System * _ a s ~3 <<-~ S~,! (Initial) Wastewater Flow: 3 (,J GPD
(See note below, if applicable}
a)D A i-- f n (Repair)
Installation RNuirements/Condillim
Septic Tank Size 100 0 gallons Exact length of each trench ~7t feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of: 9, inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
Conditions:
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 ryltem type specified it different from the type rpecifed on the app/ication. /accept the rpeciCcationr of thi permit.
Owner/Legal Representative Signature: Date:
• nUt V11 auv l a WLgULL M ie.vLaiwn a me she plan, piat, or me mtenoea use changes. Me Lonstruction Authorization shall not be transferred when there is a change in ownership
of the site. This Construction Authoriz is subject to compliant with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit.
~ c j SE ATTACHED SITE SKETCH
Authorized State Agent: Date: Vzt'~
Cons ruction Authorization Expiration Date: ~2 r a~ f S
C
HTE# Q I 1 J 3- 0 qa-7 K Permit # Z 1( y
Harriett County Department of Miblic Health
Site lkiketch
PROPERTY LOCATON: 1\31
ISSUED TO: S SUBDIVISION FA LOT #
Authorized State Agent: Date: J NVOj
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