IP-OnlyH T E # iO-S-F`7
❑ New
Basement Fixtures? ❑ Yes
Improvement Permit 2 6 2 0 7
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: V4-! 4-VV4
ISSUED TO: W y ~N Cv c~S ~ 2v4-G rt SUBDIVISION 1 tN 6r-+.1 o1 L- - LOT # lO'~
NEW REPAIR ❑ PANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: s ~0 (~O'Xls Co OQ.b.-I N ~ s eLO Pct tom. ~>s ~ >30~GA~ 127
Proposed Wastewater System Type: ~y~r,--,# i s(3 J
Projected Daily Flow: 3ro GPD o5 ~,L. ~:E-NC FF'
Number of bedrooms: 3 Number of Occupants: max
Basement ❑Yes / `No
Pump Required*,Ms ❑ No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well Y b d feet Permit valid for. ,Five years
Permit conditions:
❑ No expiration
Authorized State Agent:: Date: a 1 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the iuu of other permits. The permit hold is resp nsible for checking with appropriate governing bodies in meeting their requirements. This
allKs 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, J958. 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:
Facility Type:
Basement? ❑ Yes ❑ No
Type of Wastewater System' _
(See note below, if applicable
Installation Requirements/Conditions
Septic Tank Size gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
Number of trenches
Exact length of each trench feet
Trenches shall be installed on contour at a
Maximum Trench Depth of 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)
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 system type rpeciled is different from the type speciled on the application. /accept the specilcations of this permit.
Owner/Legal Representative Signature: Date:
This Construction Author zation 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:
Harnett County Department of Public Health
PROPERTY LOCATION:
SUBDIVISION
❑ Expansion ❑
❑ No
Repair
LOT #
(Initial) Wastewater Flow-. GPD
Date:
Construction Authorization Expiration Date: