IPACHTE# /0 ,-5-- RN 7,3-7 Harnett County Department of Public Health 2 61 7 4
Im rovement Permit
A building permit cannot be issued with only an mprovement Perm'
PROPERTY LOCATION: cm-~C4•~c>$
ISSUED T0: SUBDIVISION Me tcI LOT
NEW 2' REPAIR ❑ c EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: S Q,) `1110 Is Flo
Proposed Wastewater System T pe: ;2- S_
Projected Daily Flow: _ GPD
Number of bedrooms: ------Number of Occupants: max
Basement ❑Yes ~lo
Pump Required: 2<s ❑ No ❑ May required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet Permit valid for. eT"Five years
Permit conditions:
❑ No expiration
Authorized State Agent:: Date: 'aLCf Q SEE ATTACHED SITE SKETCH
The issuance of this permit by a 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 taws 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
with the attached system layout.
into this permit and shall be met. Systems shall be installed in accordance
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PROPERTY LO
CATION:
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- SUBDIVISION
Facility Type: J- FD 2"'New ❑ Expansion ❑ Repair
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r'•~c LOT #
Basement? ❑ Yes 2 F
No asement Fixtures? ❑ Yes ❑
0
,
Type of Wastewater System**
"
ey 4, Ln 44 oa, 1
(Initial) Wastewater FlowLJ~ 6 GPD
(See note below, if applicable
1~ ~ ,6
(Repair)
Installation Requirements/Conditions Number of trenches /
Septic Tank Size /000 gallons Exact length of each trench feet
Trench Spacing: 9 Feet on Center
Pump Tank Size /coG d gallons Trenches shall be installed on contour at a
Soil Cover: °!Z inches
Maximum Trench Depth of. /g' '24 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
Inches below pipe
C t Aggregate Depth: inches above pipe
Conditions: q Cc--J-,, `h,,k 1` inches total
(4.~ ~e l tt co2 i c„. Ca CGsI c:J e$ Q~e r Fwd tlW~~ sil 1'
If applicable. /understand the system type specr6ed rs different bom the type speciped on the application. / accept the specircati~on hIs 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 Agent- -~l Date: F 7/ c
Construction Authorization Expiration Date: /
HTE# ~a J ` ~5/7,U Permit # a ~ 7
Harnett County 1)epar(ment of Public Health
Site Sketch
PROPERTY LOCATON:
ISSUED T0:V~t~
SUBDIVISION
LOT #
Authorized State Agent:
Date:
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Department of Emirvmmant, Health and Natural Resomes
Division of Emirommental Health
On-Site Wastewater Simon
SOMME EVALUATION
for ON-,SITZ WASTZWATERSYSTFM
Owner. Applicant: a
Address:
Proposed Facility:
Locadon of Site
water supply
Evaluation Method:
Type of Wasbmtm-
Date Evaluated 7
Design Flow (.1949):
Fropat)r Recorded:
Sheet:
Property ID:
Lot
File *
Code:
Property Size:
W,ftfic ❑ Individual ❑ Well ❑ Spring
ger Boring ❑ Pit cut
Sewage ❑ Industrial Process H Mixed
❑ Other
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