IPAC RHTE #13-5- 3034,x, Hariliett County Department Of u lic dealth
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
r PROPERTY LOCATION: Doc-,se ga
ISSUED TO: r ''ANN A5'CLU0< 10N SUBDIVISION lT�n' s R.,oGc LOT # "I S
NEWX, REP ❑, XPANSION ❑ , Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: '5' 1^' A 41
Proposed Wastewater System Type: 2,S% Q C;s� OGC 110 N
Projected Daily Flow: -6 GPD
Number of bedrooms: '� Number of Occupants: �' max
Basement []Yes :ENo
Pump Required: ❑Yes ❑ No >N May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet Permit valid for: Five years
Permit conditions: ❑ No expiration
Authorized State Agent:: ` Date: t 1 s 1 0 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuance r 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 provement mit 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 Treatm`�ent and
`• pD�isposal and to conditi this
iL " -Sy+Z 1—} 1'�3 ) 7%' \ tK�l >.7
Construction uthorization
(Required for Building Permit)
The construction and installation requirements of Rules .1950, .1952, .1954, .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: �'YNra (20 i-yt-6 avC,, 1C1 At
Facility Type: S�fl `� ql New
Basement? ❑ Yes No Basement Fixtures? ❑ Yes
Type of Wastewater System ** RE-Dvc -� d too
(See note below if applicable ❑)
PROPERTY LOCATION: Q !, S (ZD
SUBDIVISION 1 "-r ESIS LOT # 7 5
❑ Expansion ❑ Repair
)R� No
'- ys -yEWN (Initial) Wastewater Flow: GPD
�Selc 'P-!CSZ0(571t00 S-)s;I-- n (Repair)
Installation Requirements /Conditions Number of trenches I
Septic Tank Size 10013 gallons Exact length of each trench aOO feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of: R 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 system type specified is different from the type specified on the app lication. / accept the specifIcations of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorization is subject to revo ' 'f the site lat, 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 s to compliance ' h the p—r.-,!t ws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State
Q"f , <,V-D L� 13115
Date: 1 »
��� �� Construe Authorization Expiration Date: t
HTE#
Permit #
ffitrylett County I )eptal- til tell t of iblic Health
Site slietch
PROPERTY LOCATON: CSC)
ISSUED TO: t 1-4
SUBDIVISION 1 7, bZ >o6C, LOT # 1S
Authorized State Agent: =�15 k��t— z01-`� Date: L}3
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