IPAC RHTE# J 3- S- (6 tZ Hared-,t County Department of Public _.zalth 27764
Imurovement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: �x6c UT ayG p��y 5-
ISSUED TO: GCE �� ®s t1�5 LLCI SUBDIVISION Q Ax.sno r47 LOT # 14H
NEW X REPAIR ❑ CNSION El Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: E FK) t b 6X L4G"
Proposed Wastewater System Type: P oho pVG'Y1 dW
Projected Daily Flow: GPD L41Q)
Number of bedrooms: Z 4 Number of Occupants: max
Basement ❑Yes X No
Pump Required: ❑Yes ❑ No eX May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 OQ feet Permit valid for:
XFive years
Permit conditions: \ ❑ No expiration
Authorized State Agent:: Date: VZLIQ3 1 )3 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no wa tees le ' a et of other permits. The permit holder is respo sible for checking with appropriate governing bodies in meeting their requirements. This
site is subject to revocation if the site plan, plat, or the i to d use change . e ell 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 Sewage Treatment �nE40 al�and t of this pe `
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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: -� c-
�_e VAo t�� LLC- PROPERTY LOCATION: E �N G Q, -
� SUBDIVISION yfyxr.otl LOT # I Li
Facility Type: �� ®'x�S`1` New El Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ Yes IX No 14 �d
Type of Wastewater System ** (Z c QLA s 0_,► Co )1 Csn (Initial) Wastewater Flow: GPD
(See note below, if applicable ❑)
M>Q_15
Installation Requirements /Conditions
Septic Tank Size a-SO gallons
Pump Tank Size gallons
(Repair)
Number of trenches L+
Exact length of each trench b .5 feet
Trenches shall be installed on contour at a
Maximum Trench Depth of: I's inches
(Trench bottoms shall be level to + / -1 /4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
Conditions:
1
Trench Spacing: Feet on Center
Soil Cover: G inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
WATER LINES (INCLUDING IRRIGATION) MUST BE LOFT. 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 application. / accept the specification of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorization is subje cation if the 'te fiat, 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 v4tNP, mpliance wi isio the s and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State Agent: \ FhS Date:
!RSva6 (11,z> 31 r�,,,) )U �, Constr Authorization Expiration Date: �'
HTE# Permit # an--I �
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