IPAC RHTE# \ -5-�3-�1 Har,..a County Department of Public _,ealth 28013
d 4,1 -- </ ®.34// Improvement Permit
A building permit cannot be issued with only an Improvf dent Permit �7
c^ PROPERTY LOCATION: L-�C. �--0 U rn 1
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ISSUED Tj :El i5 lxN �c�,c t`sEt��Q SUBDIVISION LOT # -
NEW"4 REPAIR ❑ EXPANSION
Type of Structure: Tf) I;-, i \aU ME Q 1 6 �
Proposed Wastewater System �Type: 0/0 pN :Erc�
Projected Daily Flow: �'°Q GPD
Number of bedrooms: 3 Number of Occupants: max
Basement ❑Yes �No
Site Improvements required prior to Construction Authorization Issuance:
Pump Required: ❑YesNo El May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 ®0 feet Permit valid for: Five years
Permit conditions: ❑ o expiration
Authorized State Agent:: TES Date: SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuance h permits. The permit holders respm ible 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 Permio
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 T0: �C:sv� �� �p��g(��o PROPERTY LOCATION: �--- v
SUBDIVISION LOT # —�
Facility Type: �Q-,'Z— „ 1, r'AS) �Z New ❑ Expansion ❑ Repair
Basement? ❑ Yes '�KNo Basement Fi lures? ❑ Yes No
Type of Wastewater System ** 2l -et" a vex.) e} T'f �� C GS~. (Initial) Wastewater Flow: 1 X40
(See note below, if applicable ❑) 1 {�,„
c�� d ® ice- 2W<:; )®N S-y '576—m (Repair)
Installation Requirements/Conditions Number of trenches AZ -' �^
Septic Tank Size t Q:)C D gallons Exact length of each trench ® feet Trench Spacing: 1 Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: C, inches
Maximum Trench Depth of: 11 -7D�Z.l, 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
Conditions:
ICS jC
inches below pipe
Aggregate Depth: inches above pipe
inches total
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.
* *If applicable: / understand the system type speciTed is different from the type speciTed on the application. /accept the rpecifIcationr of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorization is subjec lion if t Ian, 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 _ti ( compliance " the p o e Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State Agent: Date:J/
onstii n Authorization Expiration Date: v
Authorized State Agent:
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