IPAC RHTE# Harnett County Department of Public Health 2 6 0 4 0
Lmarovement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: N G
ISSUED TO: ~~C~~c2P. ~P.cc~pgS~LL SUBDIVISION ❑~,plL S RM:SN-*,\ LOT
NEWS( REPAIR ❑ EXPANStQN ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: 5 o0 ~36 ".10,
Proposed Wastewater System Type: Co ry i E-"-\ x D
Projected Daily Flow: Sd GPD
Number of bedrooms: Number of Occupants: `)5 max
Basement ❑Yes KNo
Pump Required: ❑Yes "D~\No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 10(~) feet Permit valid for. ;Five years
Permit conditions: ❑ No expiration
Authorized State Agent:: : - Q,~10 Date: 5 1 l SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuan other permits. The permit hol er is esponsible 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 Improvemen rmit 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 T0: PROPERTY LOCATION: Y C- aD
SUBDIVISION For. LOT #
Facility Type: S~~~ooL7d New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ Yes No
Type of Wastewater System** GO,"N EN C ~G zJ c~.t (Initial) Wastewater Flow: S~ GPD
(See note below, if applicable
hrv Esr~lc~ "~,L_ (Repair)
Installation Requirements/Conditions Number of trenches
Septic Tank Size IS-00 gallons Exact length of each trench a
Pump Tank Size gallons Trenches shall be installed on conto r at a
Maximum Trench Depth of: ~~-30
(Trench bottoms shall be level to +/-1/4"
in all directions)
feet Trench Spacing: Feet on Center
Soil Cover: inches
inches (Maximum soil cover shall not exceed
36" above the trench bottom)
Pump Requirements: ft. TDH vs. GPM inches below pipe
Aggregate Depth: a, inches above pipe
Conditions: ~ Ash L~ww ~,ts`~ s~ SC9"~,GS~SEn. ~o ~NL,y~N 5 ~a. inches total
t ' P+.-, Q7- GCLO A G) \ 1 N ~I A L CS ~
**If applicable: / uoderfwd the system type fpecified /f different from the type specified on the app/ic,?Pon. / accept the specifics Wf of this permit
Owner/legal Representative Signature: Date:
This Construction Authorization is so 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 Authorization i~t t to compliance wit rov of the laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State Agent: e-f- Date:
Co uction Authorization Expiration Date: 5
HTE# ~a 5-ate,>>5 Permit # a"O
namett County Department of iblic Healtb
Site Sketch
PROPERTY LOCATON: t-3C 2'3
ISSUED TO: grub ~Lt SUBDIVISION Ezrpo_ LOT # 5
Authorized State Agent: (oL,_60a~YSDa Date: 5} l~1Q
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