IPAC RHTE# 111 -r-33 (- Harnett County Department of Public Health 27987
Improvement Permit
S-1.0-ryJ r Ca. " ,R5, A building permit cannot be issued with only an Improve e_nt Permit
11 (� PROPERTY LO(ATION: �e I I aura � cl
ISSUED TO: h `r r�e C!}w SUBDIVISION LOT #
NEW V REPAI ❑ EXPANSION ❑
Type of Structure: `40"g
Proposed Wastewater System Type: Qv Co.,vzn�:w�`Q
Projected Daily Flow: Y.5-0 GPD 9A1 1. ",l ��p�d�`i
Number of bedrooms: Number of Occupants: a `ama3tJe���
Basement ❑Yeses 2�No
Pump Required: ZYes ❑ No ❑ May be required b ed on final location and elevations of facilities
Type of Water Supply: ❑ Community ❑ Public Z Well Distance from well /00 feet
Permit conditions:
Site Improvements required prior to Construction Authorization Issuance:
Permit valid for:
LTf Five years
❑ No expiration
Authorized State Agent::`,Z � Date: F f /J—LZ0151 SEE ATTACHED SITE SKETCH
The issuance of this permit by the 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, .1952, .1954, .1955, .1956, .1957, .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: �S-�; r %ems C,
PROPERTY LOCATION:
Facility Type: C oJ
SUBDIVISION
21New ❑ Expansion ❑ Repair
LOT #
Basement? ❑ Yes Cr No Basement Fixtyfes?
P
❑ Yes ❑ No
Type of Wastewater System **
011 ...Q
(Initial) Wastewater Flow: r5 5'0 GPD
(See note below, if applicable ❑)
�)
C6Ayk.�T'i (Repair)
Installation Requirements /Conditions
Number of trenches q
Septic Tank Size /a r0 gallons
Exact length of each trench /00 feet
Trench Spacing: Feet on Center
Pump Tank Size / a 5'0 gallons
Trenches shall be installed on contour at a
Soil Cover: / ' / 8 inches
Grve .re Try t coo 5-410^f
Maximum Trench Depth of. aq -30 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: Z 1�' +'AkF a.-<- s. //el"c0 ar
Mvf4- be- 7Tr-c.-JC-f-=c �v Eel %-tiKr , eS�r t
(-- inches below pipe
Aggregate Depth: � inches above pipe
(All J L t1 � + inches total
c-. 1Je QJ ;or 4-,u I '( o k
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 specified is different from the type specified on the application. / accept the specifications of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorization is subiect to revocation if the site Plan. Plat, or the intended use chanties. The Construction Authorization shall not be transferred when there is a change in ownershin 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: A&Z Date: 4F 115- 1,2 0 /S/ _
Construction Authorization Expiration Date: 4 aC, /Y
HTE# / y— S-- 33G,27 2 Permit #
Harnett County Department of rblic Health
Site sketch
11 PROPERTY LOCATON:
ISSUED T0: 4 Z"I MCb SUBDIVISION LOT #
Authorized State Agent: / "`mac ��. /� r Date: !
pe_f 11:11 rz , -Z If
4-
f�o-s
Number of Seats: d
Facility total square feet: o? 00
Projected start date: 9LI by
Type of Food Service:
Restaurant
Food Stand
Drink Stand
Commissary
Meat Market
Other (explain):
Y
Utensils:
Check all that apply
Sit down meals
Take -out meals
a/ Catering _
Multi -use (reusable): Single -use (disposable):
Food delivery schedul (per week): 1_9 }C W Ge.%
,qf(V x 100 ryIWS / Wet k u �`� b e -I'ctke n a' s t 4.
Indicate any specialized process t at will take place: -
Curing Acidification (sushi, etc.) Smoking
Reduced Oxygen Packaging (e.g. vacuum packaging, sous vide, cook - chill, etc.)
Has the process been approved by the Variance Committee of the DPH Food
Protection Branch?
Indicate any of the following highly susceptible populations that will be catered to or
served: r
Nursing /Rest Home Child Care Center Health Care Facility
Assisted Living Center School with pre - school aged children or an
immunocompromised population
Page 3 of 10