IPACHTE# —� -3 2,`15 Hari —a County Department of Public - .ealth 28026
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: SoUi,J 9-=; 4641
ISSUED TO. 0c'NG- ,{..:1t, SUBDIVISION LOT #
NEW REPAIR ❑ EXP ION I-] Type of Structure: MoD
Proposed Wastewater System Type: `� �� o t) J (n
Projected Daily Flow: 36q GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes No
Pump Required: ❑Yes No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet Permit valid for: Five years
Permit conditions: ❑ No expiration
Authorized State Agent:: Date: '4 `� 11i SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issua ther permits. The permit holders res nsible 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 Improveme ermit 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..
Site Improvements required prior to Construction Authorization Issuance:
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 into this permit and shall be met. Systems shall be installed in accordance
with the attached system layout.
ISSUED TO: PROPERTY LOCATION:
SUBDIVISION LOT #
Facility Type: M U® ]C�� New ❑ Expansion ❑ Repair
Basement? ❑ Yes 35� No Basement Fixtures? ❑ Yeslo
Type of Wastewater System * *S�l.� (Initial) Wastewater Flow:3 (-G GPD
(See note below, if applicable ❑)
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Installation Requirements /Conditions
Septic Tank Size 1 a ® O 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: A 30 inches
(Trench bottoms shall be level to +/ -1/4"
in all directions)
GPM
Trench Spacing: `) Feet on Center
Soil Cover: C,4 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 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 .specified is different from the type specified on the application. I accept the specifications of this permit.
Owner /Legal Represen ' j nature: Date:
This Construction Authorization is subject to rev n ' e 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 ,to comp i with —th of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: Date:
Cons tion Authorization Expiration Date: S
HTE# � Li - 5 T Permit #
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Department of Environment, Health and Naturai Resources
Division of Environmental Health
On -Site Wastewater Section
SOIL /SITE EVALUATION
for ON -SITE WASTEWATER SYSTEM
Owner: Applicant:
Address: Date Evaluated:����
Proposed Facility: 3 gpQ%N Design Flow (.1949):'
Location of Site: Property Recorded:
Water Supply: Public❑ Individual ❑ Well
Evaluation Method - -Auger Boring ❑ Pit ❑ Cut
Type of Wastewater: Sewage ❑ Industrial Process
Sheet:
Property ID:
Lot #:
File #:
Code:
Property Size:
❑ Spring ❑ Other
❑ Mixed
P
R
O
F
I
L
E
#
.1940
Landscape
Position/
Slope %
Horizon
Depth
(In.)
SOIL MORPHOLOGY
.1941
OTHER
PROFILE FACTORS
—
Profile
Class
& LTAR
.1941
Structure/
Texture
.1941
Consistence
Mineralogy
.1942
Soil
Wetness/
Color
1943
Soil
Depth (IN.)
.1956
Sapro
Class
.1944
Restr
Horiz
37 S
G
C-
\i Fl
Description
Initial
S ste
Re air System
Other Factors (.1946):
Site Classification (.1948 j?f
Evaluated By:d�
Others Present: —
Available Space (.1945)
System Type(s)
"'1c
Site LTAR
-s
37 S