IPACH T E # Zo-,rC?, q,5-C) ,Z- Harnett County Department of Public Health 26 1 53
Improvement Permit
A building permit cannot be issued with only an Irilprovement Permit
PROPERTY LOCATI All
l Q,_ ;=r P~.
ISSUED i0: SUBDIVISION c«1f !L
NEW ~ REPAIR 11 ~ EXPANSION ❑ LOT #
Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: k~'G
Proposed Wastewater System Type: a 5- e ~c - t~ti M
Projected Daily Flow: _a_ I'D
Number of bedrooms: ~ Number of Occupants: max
Basement ❑Yes Lilo
Pump Required: ❑Yes ❑ No E?"u May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community lic ❑ Well Distance from well feet
Permit conditions: Permit valid for. -f-7-Five years
❑ No expiration
Authorized State Agent:: c,~e Date: 6 Q Q/ G
The issuance of this permit by a Health Department i o way guarantees the issuance of other permits, The permit holder is responsible for checking with appropriate governing bodies E ATTACHED SITE SKETCments. 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, .1957, .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: C /c~tiC,~ PROPERTY LOCAT N: ~r jc tr
Facility Type: SUBDIVISIONL t-{ra`( LOT #
~ew ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? EJ Yes No
Type of Wastewater System** '.2 S_7 i-A-
U
(Initial) Wastewater Flow GPD
(See note below, if applicable 11
(Repair)
Installation Requirements/Conditions Number of trenches J
Septic Tank Size , Q00 gallons Exact length of each trench 1 SO feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of: _ .2o inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
inches below pipe
inches above pipe
inches total
**If applicable: / understand the system type specified /s different from the type specified on the app/icdtion. / accept the specill'wionr of thif permit.
Owner/Legal Representative Signature:
Date:
This fonstraction 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
Trench Spacing: Feet on Center
Soil Cover: _ /a inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
Authorized State Agent: 61, //f
Date: i
Construction Authorization Expiration Date: _ 6
HTE# /C" = 0? 0~-
Permit # c~ kc) 1r3
Harnett County Department of "l blic Health
Site shetell
` I~ PROPERTY LOCATON: 1 -~„Y dD
ISSUED TO: EKG ( 9l' SUBDIVISION LOT #
Authorized State Agent: of Date: 6 X°~~
C
Department of Environment, Health and Natural Resources
Division of Environmental Health
On-Site Wastewater Section
SOIIJSITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
Owner Ap
Address
Proposed Farcilitr
Location of Site:
Water Suppli
Evaluation Method:
Type of Wastewater:
lican~
P Date Evaluated:' I a
Dedglt Ftow (.1949):
i Propedy Recorded:
lk ❑ Individual ❑ Well
Auger Boring ❑ Pit
Sewage ❑ Industrial Process H
Sheet:
Property ID:
Lot
File
Code:
Property Size:
❑ Spring ❑ Other
cut
mixed
P
R
0
F
1
1940
OIL 4tORPHOLOOY
.1941
THER
PRaYU PACTOR3
L
E
N
La Wsm"
PoridoW
Slope %
Hod us
Depth
(la)
1941
shueh"
Ted
.1941
Coniidaw
Mtnerelo
.1941
Soil
wetmw
Coto
.1043
soil
D-A 01.
.1956
Sepre
Claw
.1944
Redr
Halt.
P(Oft
clue
AL?Alt
/
Other Factors (.1946X
Site ClassiHcadon (.1948X f
Enhated W.
Others Present