IPACHTE# 1`5-a -'-MZ,0'3 Harnett County Department of Public Health
Improvement Permit 2 % 5 4
A building permit cannot be issued with only an Improvement Permit
i PROPERTY LOCATION: �1oatL f,.�t_
ISSUED T0: �c MES l �1-� SUBDIVISION LOT #
NEW%�7 REPAIR ❑ —EXPANSION ❑
Type of Structure: "V�p �.��''t--tl.ar
Proposed Wastewater System Type: 2�1a -aUGS i 5J 5
Projected Daily Flow: GPD
Number of bedrooms: Number of Occupants: i max
Basement []Yes No
Site Improvements required prior to Construction Authorization Issuance:
Pump Required: ❑Yes -4;�No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well i feet Permit valid for: Five years
Permit conditions: ❑ No expiration
Authorized State Agent: `"\5 Date: - ' , SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the of
mpr 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 I t 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: nC - -G-cc Nrnr--Z!, U.... C— PROPERTY LOCATION: Cv pNfeL'4
Facility Type: 5 ��
Basement? ❑ Yes '�a No Basem
Type of Wastewater System" �o
(See note below, if applicable ❑)
Installation Requirements /Conditions
Septic Tank Size i 247 C7 gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
SUBDIVISION LOT #
New ❑ Expansion ❑ Repair
!nt Fixtures? ❑ Yes No
P,eQ S y y5 s (Initial) Wastewater Flow: (�UC3 GPD
�vG'S 10 1-J N t✓ n (Repair)
Number of trenches
Exact length of each trench > feet
Trenches shall be installed on contour at a
Maximum Trench Depth of. 1�`�� i inches
(Trench bottoms shall be level to +/ -1/4"
in all directions)
GPM
Trench Spacin : Feet on Center
Soil Cover:' la. inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
WATER LINES (INCLUDING IRRIGATION) MUST BE IOFT. FROM ANY PART OF SEPTIC SYSTEM OR REPAIR AREA.
NO UTILITIES ALLOWED IN INITIAL OR REPAIR DRAIN FIELD AREA.
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 speci( cations of this permit.
Owner /Legal Represeutative Signature: Date:
This Construction Authorization is subject ation 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 Authorization is s complian ith cof the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State Agent: \ Date: '=
onstruction Authorization Expiration Date: —
HTE#
ISSUED TO:
Authorized !
H"trilett County Department of Mtblic He(.I;Itll
Site sketch
PROPFRTY I O(AMN- V"IM0 I-- C, C blcQ it I - \�
Department of Environment, Health and Natural Resources
Division of Environmental Health
On -Site Wastewater Section
SOIL /SITE EVALUATION
for ON -SITE WASTEWATER SYSTEM
Owner: Applicant:
Address: Date Evaluated:
Proposed Facility: 569Z a"�'� Design Flow (.1949): 6-bO v-d
Location of Site: Property Recorded:
Water Supply: ublic❑ Individual ❑ Well
Evaluation Method -Auger Bo 'ng ❑ Pit ❑ Cut
Type of Wastewater: .Sewage ❑ Industrial Process
Sheet:
Property ID:
Lot #:
File #:
Code:
Property Size:
❑ Spring ❑ Other
❑ Mixed
P
R
O
F
I
L
E
#
.1940
Landscape
Position/
Slope %
Horizon
Depth
(In.)
SOIL MORPHOLOGY
.1941
OTHER
PROFILE FACTORS
Profile
Class
& LTAR
.1941
Structure/
Texture
.1941
Consistence
Mineralogy
.1942
Soil
Wetness/
Color
.1943
Soil
Depth (IN.)
.1956
Sapro
Class
.1944
Restr
Horiz
4S
S>� GL
S5J"510
?
G
VrC L A4 f
c z2
:s-5J
g�LV
Description
Initial
System
Repair System
Other Factors (.1946):
Site Classification (.1948): f
Evaluated By:s, :)
Others Present: ---
Available Space (.1945)
System Type(s)
5
\ E
Site LTAR
1 4