IPACHTE# i0-J- agCOI Harnett County Department of Public Health 2 61 5 9
Improvement Permit
A building permit cannot be issued with only an Improvement Pe
PROPERTY LOCAT N: S74 f ~ C c ~Ie 4.
ISSUED T0- V ~/1 cl,A SUBDIYISION LOT #
NEW f~ REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: b 3 -7 7( d2
Proposed Wastewater System Type: 5-v A-d 11 r f~ S r~
Projected Daily Flow: GPD
Number of bedrooms: Number of Occupants: ~v max
Basement ❑Yes PIN-o
Pump Required: ❑Yes ❑ No 2 /Ma, be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet Permit valid for: E~-F-ive years
Permit conditions: ❑ No expiration
Authorized State Agent.: yJ Date: ~ ~0 ZCt C? SEE ATTACHED SITE SKETCH
The issuance of this permit by e Health 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, .195
with the attached system layout
2, .1954, .1955, .1956, .1957, .1958. and .1959 are incorporated by references into this permit and shall be met. Systems shall be installed in accordance
ISSUED TO: V Ass Co-LS J, a0- PROPERTY LOCATI N
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Facility Type: sic-0
SUBDIVISION
r.~ OLAt e,rese, --r LOT #
0 New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement
fxtures? ❑ Yes ❑ No
Type of Wastewater System*' to ,
~er~vr
(Initial) Wastewater Flow: - GPD
(See note below, if applicable
~~~.wa f~/l ~cr (Repair)
Installation Requirements/Conditions
Number of trenches .2
A-1
Septic Tank Size gallons
Exact length of each trench ~S feet
Trench Spacmn : Feet on Center
Pump Tank Size gallons
Trenches shall be installed on contour at a
Soil Cover: t'2 inches
Maximum Trench Depth of: G 'o? inches
(Maximum soil cover shall not exceed
(Trench bottoms shall be level to +/-1/4"
36" above the trench bottom)
in all directions)
Pump Requirements. ft. TDH vs. GPM
Condition;:
v r re.P < r e.. s!
Its
ct-F.1,+ vC' 4l1-- gP C~- D~.l ~kp w•~
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*'If applicable: /understand the ryrtem type Speci6ed it different from the type rpecired on the
inches below pipe
Depth: inches above pipe
inches total
1 ~~.cJ C c kl.) •z 'A a n S"v f`
accept the .rpecillcations 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 Age
Date: 6 12Z-
Construction Authorization Expiration Date.
HTE # f C - ,S` = RV C! Permit # oZ 1,t~ ~ S
Harnett County, Depailinent of Public He alth
Site Sketch
PROPERTY LOCATOR
ISSUED TO: V -~y4A A SUBDIVISION LOT # I.~'
Authorized State Agent: tiss Date: 2 Z 2 f d
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Department of Environment, Health and Natural Resources Shed:
Division of ErMmumenW Health Property ID:
On-Site Wastewater Section Lot Property
SOQJSTTS EVALUATION File M:
f ON Code:
or ,SITS WASTMAT1ES SYSTEM
Owner. Applicant: ~
Address
Date Evaluated:
Proposed Facilitrr:
DeMp Flow (.1949Y
Property Size:
Location of Site:
- Property Recorded
Watd $upw , He ❑ Individual ❑
Well
D Spring
Evaluation Method:
Type of Wastewater;
,.Auger Boring ❑ Pit
S
~
Cut
ewage Industrial Process
[
Mixed
P
it
O
P
M al NORMLOOY
1
L
.1940
Laub
H
i
.1941
R
PROFR.R FACTI
8
a
"
Position/
slop.'1~
or
zoe
Depth
00
.1941 .1941
st
w
.1941
sou
141
uem
Conddem
Texpw MIMM10
wowed
Color
sou
Mod (IN
)
7
7 i A(-ir1.
.
c v
,r•~•o txner Factors (.1946x
'e site Clawncation (.1948k -s-
Evaluated By.-J/1
- Othas Prem*
D other
.1976 .1944 boa
seprar Restr CIM