IPAC RHTE# 106-560IS7s3 Harh(ta County Department of Public tlealth 23380
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: / I I L
ISSUED TO: S SUBDIVISION w ( H. / IJ LOT #
NEW REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: S2) )t3 t
Proposed Wastewater System TyPe J41--
Projected Daily Flow: '2 IL,0 GPD
Number of bedrooms: 3 Number of Occupants: max
Basement Oyes ONo
Pump Required: ❑Yes 14 No XMay be required based on final location and elevations of facilities
Type of Water Supply. ❑ Community P is ❑ Well Distance from well feet Permit valid for. 1~rhve years
Permit conditions: te~ onj i ❑ No expiration
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Authorized State Agent:: Date:
~1--O o`~- 0- (k~ ID SEE ATTACHED SITE SKETCH
The issuance of this permit by )(e 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
Aggregate Depth:
Conditions:
inches below pipe
inches above pipe
inches total
*`If applicable: /understand the system ty pe specified is diNerent from the type specifies on the application. / accept the specitcatrons of this permit.
Owner/Legal Representative Signature: Date:
(Required for Building Permit)
The construction and installation requirements of Rules .1950, .19y3, .1954, ASS, .1956, .1957, .1958, and .1959 are incorporated by references into this permit and shall be met. Systems shall be
installed in acw ce wit the ath d syste layout.
ISSUED T0: Ae / ,~.~PROPERTY LOCATION: I ~ X40
~~x3 ( SUBDIVISION r~,~sn.y~~ 11} LOT #
Facility Type: New F-1 Expansion El Repair
Basement? ❑ Yes No Base ent Fixtures? El Yes 'No
Type of Wastewater System"* (initial) Wastewater Flow: D ~ ~ GPD
(See note below, if applicable
(Repair)
Inst~Nation kgnuaneats/[oaditiaas
Septic Tank Size gallons Exact length of each trench 2a C feet Trench Spacing: Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover. C. inches
Maximum Trench Depth of: I 7S inches (Maximum soil cover shall not exceed
(Trench bottoms shall be level to +/-1/4" 36" above the trench bottom)
in all directions)
Pump Requirements: ft TDH vs. GPM
ins comsrurnon Autnonzauon is suolect to revocation n me 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 Authorizaf 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 Date: ` (col" t
Construction Authorization Expiration Date: 0-2 -t Y ~J t
HTE# Permit #3 Zk
Harriett County Department of 1'41blic Health
Site Sketch
PROPERTY LOfATON: { ~I I
ISSUED TO: i~ ~ SUBDIVISION Q 4 J~V~ A , I Lj LOT # 3T-
Auth zed State Agent: Date: C Q- h<- a--) l~)
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