IPACNTE# o -s-a~a, Harnett County Department of Public Health 2 5 8 8 9
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: R Ay p!Z f1 r L A("KS 'ZD
ISSUED TO: SUBDIVISION
NEW REPAIR Q EXP ION ❑ LOT #
Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: (~)F cj
Proposed Wastewater System Type: C_o ra-lEnt"C ~d tit p t-
Projected Daily Flow: G C_)Q GPD
Number of bedrooms: S Number of Occupants: ► ti max
Basement ❑Yes V No
Pump Required: ❑Yes ❑ No X May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Q Public ❑ Well Distance from well t O Q feet Permit valid for. Five years
Permit conditions:
❑ No expiration
Authorized State Agent:: Date: ~l ► CJ SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issua 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 Improvem 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 Permitl
The construction and installation requirements of Rules 1950, .1952, .19$4, .1955, .1956, .1951, .1958. and .1959 are incorporated by references into this permit and shall be met. Systems shall be installed in accordance
with the attached system layout
ISSUED TO: \IJ C-t) I \14 CL -1, _
Facility Type: S '~D C$C1~5~ X New
Basement? ❑ Yes No Basement Fixtures? ❑ Yes
Type of Wastewater System' Co"-4 C- 4-", a N pCl~
(See note below, if applicable
PROPERTY LOCATION: Q
SUBDIVISION
❑ Expansion
No
LOT #
(Initial) Wastewater Flow: (0(!S6 GPD
C<9 rtvC~ w 0'>.'L_ (Repair)
Installation Requirements/Conditions Number of trenches 3
Septic Tank Size l'aiSO gallons Exact length of each trench 85 feet Trench Spacing: cJ Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: Sa-')q inches
Maximum Trench Depth of: _ °1 LAinches (Max ff= soil cover shaA not exceed
(Trench bottoms shall be level to +/-1/4" 36" above the trench bottom)
in all directions)
Pump Requirements: ft. TON vs. GPM
inches below pipe
Agg~r_egate Depth: _ inches above pipe
Conditions: Comer %V1 KZ."e CO "11b LIH fl~
F n. ~T at.~, 1~-Atav'; . WAC~. (s E ~1u~ 6>; 10~ Sit 5Ys-~r> inches total
**If applicable: /understand the rystem type specified /s different from the type specified on the app/icatian. /accept the apecircationa of this permit.
Owner/legal Representative Signat Date:
This Construct on Authorization is subject to revocation i e p ~of
or the intended use changes. The Construction Authorization shall not be transferred when there is a change in ownership of the site. This
Construction Authorzatan is s ' ct t mpliance with p law
s and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: 'N S 'N-1 y7~~ Date: a
on on Authorization Expiration Date: ~ -.0- )r
oR, t\ CA_>""&
❑ Repair
NTE# l C~` ~a36"~~, Permit # a5~$~
Harnett County Depa Brent of Public Health
Site Sketch
PROPERTY LOCATON: 9-n"00-
ISSUED T0: u BDIVISION LOT #
Authorized State Agent~~ QC-~S t J~L. `COL~G$UC!(~Y'
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Date: A)2 10
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4n-Site Wastewmr Sao Pfopfty ID:
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for ON sfflg WAST[WATZR SYSTZM Code:
Date Evaluated:
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