IPACNEW Z'— REP R ❑ <RPANSION ❑
Type of Structure:
Proposed Wastewater System Type: Z5
Projected Daily Flow: b'' GPD
Number of bedrooms: Number of Occupants: n max
Basement ❑Yes
Pump Required: ❑Yes ❑ No 9�ay required based on final location and elevations of facilities
Type of Water Supply: ❑ Community E Public ❑ Well Distance from well feet
Permit conditions:
Site Improvements required prior to Construction Authorization Issuance:
Permit valid for: 2-five years
❑ No expiration
Authorized State A�eA ---' — Date: .10 - I `" I.5 SEE ATTACHED SITE SKETCH
The issuance of this permit by t alth 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
(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 / ut PROPERTY LOCATION:, 5Z ;Z Ato
SUBDIVISION LOT #
Facility Type: ' New El Expansion El Repair
Basement? 1:1 Yes No Basement Fixtures? ❑ Yes afo
Type of Wastewater System - o5 0,,i6 3 .. (Initial) Wastewater Flow: '1,90 GPD
(See note below, if applicable ❑)
--s (Repair)
Installation Requirements /Conditions Number of trenches
Septic Tank Size gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
Exact length of each trench lt5aj feet
Trenches shall be installed on contour at a
Maximum Trench Depth of: Z `l Mty inches
(Trench bottoms shall be level to +/ -1/4"
in all directions)
GPM
Trench Spacing: Feet on Center
Soil Cover: inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
1-e — inches below pipe
Aggregate Depth: / inches above pipe
inches total
WATER LINES (INCLUDING IRRIGATION) MUST BE ]OFT. FROM ANY PART OF SEPTIC SYSTEM OR REPAIR AREA.
NO UTILITIES ALLOWED IN INITIAL OR REPAIR DRAIN FIELD AREA.
* *If applicable: /understand the r,wem type rpecifed is different from the type speciled on the app /ication. /accept the rpecifications of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorization 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 Authorization is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State Ag ^---� � � Date: /0-1—(3
Construction Authorization Expiration Date: /0-1 "/ 0
HTE# —,3ZI l Permit
Harnett County )epart ent of 11Vblic Health
Site Sketch
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