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IPACHTE# IOHarnett County Department of Public Health 2 6 0 3 3 Improvement Permit A building permit cannot be issued with only an Improvement Permit PROPERTY LOCATION: C-'~ VaP ,v, Q-a ISSUED TO: M s C-0c tGL Q M, o SUBDIVISION ~~'oE J Ga.-Opc, t,4 LOT # NEW REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance: Type of Structure: 5F 0 `QKz G& wI go"Us' &or- Proposed Wastewater System Type: c7 S` le V-G-Oy o N S->;VC Projected Daily Flow: GOO GPD Number of bedrooms: 5 Number of Occupants: ID max Basement ❑Yes 'X No Pump Required: ❑Yes ❑ No May be required based on final location and elevations of facilities Type of Water Supply: ❑ Community ~U_ Public ❑ Well Distance from well t©O feet Permit valid for. Five years Permit conditions: ❑ No expiration Authorized State Agent:: Date: 5 ~ 14 ~d SEE ATTACHED SITE SKETCH The issuance of this permit by the Health Department in no way guarantees the iss nce ' er 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, .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: M % (>,E2, GrA" d," C3 av} facility Type: S'~: J Cqp~ q-~,,GC-- lz GV,.-, New Basement? ❑ Yes No Basement Fixtures? ❑ Yes Type of Wastewater System** 'J (See note below, if applicable 0 Installation Requirements/Conditions Septic Tank Size la' cO gallons Pump Tank Size `!rvr gallons Pump Requirements: ft. TDH vs. PROPERTY LOCATION: E ~p ~fl (Gct, F GwD SUBDIVISION LOT # ❑ Expansion ❑ Repair No (Initial) Wastewater Flow: 60CJ GPD RE°"CScD" S) 5; C-- f' (Repair) Number of trenches Exact length of each trench Trenches shall be installed on contour at a Maximum Trench Depth of: 1$ (Trench bottoms shall be level to +/-1/4" in all directions) GPM feet Trench Spacing: 9 Feet on Center Soil (over: (~7 inches inches (Maximum soil cover shall not exceed 36" above the trench bottom) inches below pipe A regate Depth: inches above pipe Conditions: ~ ~ r ~ M ur ~C \C) Si oc-' SZ.-7 )L Sy$ SC r~ , 1Jo } L\~E5 inches total t r?+ 1 E- llCQ~ALZ\ C, 1 \ W'Tl) _ o!2- ~GPy\cL rr'~ct 6 ~s . **If applicable: l anderstand the system type specified is different from the type specified on the application. / accept the specifications of this permit. Owner/legal Representative Signature: Date: This Construction Authorization is subiect to'`r-Ramrinn if rho 6to nlan nlnt nr rho intondad -a Ann- Tha rnn<rrn r{ ~ A ,eh-i-t a AA tie --&-A , . .k...:. _L:_ _ Construction Authorization is YUbjecY fvcompliance th the kk's SEE he Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit ATTACHED SITE SKETCH Authorized State Agent: Date: S Cons_ iwtion Authorization Expiration Date: ~l 5 HTE# Permit # 2~~33 Harnett County Department of l'~iblic Health Site Sketch PROPERTY LOCATON: ISSUED TO: NocJ SUBDIVISION Shy Gtt GF~N LOT # Q- Authorized State Agent: L"4 GSL T~ ~Sfl~R~ Date: SI L4 11 b .---rte'`--~-- 1 toQ ` '~l f I ~ 9 v E w 0 0' i Department of Environment, Health and Natural Resources Sheet: Division of Environmental Health Property ID: ` On-Site Wastewater Section Lot File SOHJSM EVALUATION Code: for ON,SITE WASTEWATER SYSTEM Owner Applicant: Addrem Date Evaluated: 5)3110 Proposed Facility: S ew~wo~ esign Flow (.1949): (~oc Property Size: Location of Site: ropey Recorded: water suppity Public ❑ Ulividual ❑ Well ❑ Spring ❑ other Evaluation Method: Auger Boring ❑ Pit CIA Type of Wastewater ja Sewage ❑ ftWustrial Process Mixed P R O F 301, MORPHOLOGY OTHER 1 L .1940 L b H .1941 PROFILE FACTORS E M am " Posidoo/ 81opn % orizon DMA 00 .1941 sftch" .1941 Cotddam, .1941 9011 .1043 wet umd .1916 .1944 Prolfl. Fi Texham Minunlo soil Cola D*A IN. Swe Clan Retr Horiz Ctmw A LTA>R S. a°%o d 1>~ 5 L YFci Ms }n~ } IA 30 sgu S. CL vc cL s) s~ .3 a D-) fc, t 6-31 sQ,c ~ c~ ~'n, s 1~ 31 S C F rL s/S ~ ~-3~ G 5 ~ JFn,rslntp a 3~ SOY, Sc.,z rrL. ss 1py 3t, Pf ~ l.~l G a 1. Jan r,r5 Irk 1 T S~ 30 sgX.sci Fc~ +wWw7Pu4m Sydow Other Factor', (.1946X:: Site Ctai&adon (.1948X Eveh ated fir Othm Prexnt: ~ 5,10 14 r, .3s