IPAC RHTE# r X Harm,, County Department of Public i,,,alth
28074
ImDrovement Permit
A building permit cannot be issued with only an Improvement Permit
i f6 PROPERTY LOCATION: 14& ,1 446 9 ,
ISSUED T0: SUBDIVISION 1 — t! i -9 LOT #
NEW REPAI ❑ _ -1 EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: 1
Proposed Wastewater System Type:
Projected Daily Flow: g6o GPD
Number of bedrooms: °'f Number of Occupants: - max
Basement ❑Yes DINo
Pump Required: ❑Yes ❑ No 2 Moe required based on final location and elevations of facilities
Type of Water Supply: ❑ Community L1° Public ❑ Well Distance from well feet Permit valid for: Ei- ve years
Permit conditions: ❑ No expiration
Authorized State Ag Date: / e? - 7 -- t i SEE ATTACHED SITE SKETCH
The issuance of this per 6A b �e 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, .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:.,'f14e _� * ���ti _ PROPERTY LOCATION:
SUBDIVISION LOT #
Facility Type: � " New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtu es7 ❑ Yes 0 �
Type of Wastewater System** (Initial) Wastewater Flow: 4Ay GPD
(See note below, if applicable
G r epalr
Installation Requirements/Conditions V Number of trenches _4, q
Septic Tank Size 1,2L60 gallons Exact length of each trench AO feet Trench Spacing: Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil (over: inches
Maximum Trench Depth of: V) ($ 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 4 inches below pipe
Aggregate Depth: �%_ inches above pipe
Conditions: C'r� t, ( - '? �� 1� ,,o 4 inches total
--A .5 r-t+-19
WATER LINES (INCLUDING IRRIGATION) MUST BE 10FT. 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 specifed 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 Dian. Dlat. 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 Date: t ° "�
Z�2� /Y
Construction Authorization Expiration Date: / ®- -z - / i
HTE# -39 5 # 2-86 47
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