IPAC RHTE# 0-5- -X8,364 f Harne"a County Department of Public I Ath 24123
Improvement Permit
A building permit cannot be issued with only anprovement Pe it
PROPERTY LOCATION: A._ °~•"a Is C
ISSUED T0: C<l C.1S ~ f " . ~ & n> SUBDIVISION a k 0.' P o.~..'L LOT #
NEW Lk' REPAIR El EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: S Fez ~J- X E,
Proposed Wastewater System Type: cc ~,d 4P ti
Projected Daily flow: '.lao GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes
Pump Required: ❑Yes 10 No ❑ Ma be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community FLf Public ❑ Well Distance from well feet Permit valid for. El-Five years
Permit conditions: ❑ No expiration
IL - Authorized State ABenC / / ~L~,,.~ c ''e f 2e~
Date: SEE ATTACHED SITE SKETCH
The issuance of this pem' y the 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
ldin Permit
(Required for-401
The construction and installation requirements of Rules .1950, .1951, .1954, .1955, .1956, .1951, .1958. and AM are incorporated by references into this permit and shall be met Systems shall be
installed in accordagce with the at ached system layoy{.
ISSUED T0: err PROPERTY LOCATION: v~ r l~
SUBDIVISION "I, 6J, LOT #
facility Type: FO -7d t V "'New ❑ Expansion ❑ Repair
Basement? ❑ Yes No asement Fixtures? ❑ Yes ❑ No
Type of Wastewater System" c i-,J (Initial) Wastewater Flow: j(- a GPD
C. t bel ;f 1' bl ❑
( e "v e ow, t app tca e )
(Repair)
Installation lNuirentetWConditioni
Septic Tank Size /CO gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Exact length of each trench feet
Trenches shall be installed on contour at a
Maximum Trench Depth of / e - o? q inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
Trench Spacing: g Feet on Center
Soil Cover. C 2 inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Conditions: J'-', " ["'r ,
inches below pipe
Aggregate Depth: inches above pipe
inches total
"If aoAlicabie: l understand the trstem type specified ii different from the type specified on the application. l accept the rpecifIcationr of this permit.
Owner/legal Representative Signature: Date:
This (onstruction Authontation is subject to revocation if the 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 Authonta( subject to compliance with the provisions of the Laws and Aules for Sewage Treatment and Disposal and to the conditions of this permit.
SEE A ACHED SITE SLIM
Authorized State Agent, f Date: / G ~ce7
Construction Authorization Expiration Date: %r 2G1Zus~,Z
HTE# 0-7-J ' % L 7~- q ~ Permit # .-4 r ~0
Ha nett County Department of hiblic Health
Site Sketch
PROPERTY LO ATON: ~cvJs
ISSUED TO: ► u.(c SUBDIVISION wit a a.- LOT #
Authorized State Agen f Date: 4zJ 2G A<<'7