IPACHTE# Harnett County Department of Public Health
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Improvement Permit
A building permit cannot be issued with only an Improvement Permit p
PROPERTY LOCATION: M<V0 QGt,1-o w
ISSUED TO: Moss "0Mi-Q MLLE.— SUBDIVISION MCQoyG'NLD p-.s�C�f LOT # 1�
NEW REPAIR EXPAN, ON ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: C3 FQ�Lt5
Proposed Wastewater System Type: �-5®/a uc5 t a ys EKl
Projected Daily Flow: '3G® GPD
Number of bedrooms: 3 Number of Occupants: Qo max
Basement ❑Yes ANo
Pump Required: ❑Yes t No May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community ,X Public ❑ Well Distance from well lt)0 feet Permit valid for: Five years
Permit conditions: ❑ No expiration
Authorized State Agent:: Date: I 1 -�0)1 ).-5SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarante ance of other permits. The permit holder is respo Bible 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 s ment 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 T0: M Oc--�E.bul L-a)C ff PROPERTY LOCATION: fn<00 u G 4aug VA)
SUBDIVISION 'iY1 -Q,,,(; LOT # tC�
Facility Type: 5F'1� ��� nS� New ❑ Expansion ❑ Repair
Basement? ❑ Yes 12', No Basement Fixtures? ❑ Yes �No
Type of Wastewater System' rel 7 y 1 d sof S �> C (Initial) Wastewater Flow: 3C� GPD
(See note below, if applicable ❑) tl/
S < N;�. C6 N (Repair)
Installation Requirements/Conditions Number of trenches 1
Septic Tank Size I n O 0 gallons Exact length of each trench —Q:�).5 feet Trench Spacing: �1 Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil (over:_ i� inches
Maximum Trench Depth of. 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
Aggregate Depth:
Conditions:
WATER LINES (INCLUDING IRRIGATION) MUST BE IOFT. FROM ANY PART OF SEPTIC SYSTEM OR REPAIR AREA.
NO UTILITIES ALLOWED IN INITIAL OR REPAIR DRAIN FIELD AREA.
inches below pipe
inches above pipe
inches total
**If applicable: /understand the system type specified is different from the type specified on the app/kation. / accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
Tris -Authorization 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
su
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Construction Authorie Jetr nce withBions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: c ���`\\t � ; Date: 3D
Authorization Expiration Date:
-f,
HTE # 15 - 5 - '5'tel Permit
ISSUED TO:
Authorized State Agent:
Harnett County ]Department of 1"ublic Health
Site Sketch
PROPERTY LOCATON:
�CjcYrc:FALQ f 1 -o6 -a- SUBDIVISION L41, cf— LOT #
A'-- CO Ll NJS'Q— -TO
Date:
I
s
Q�
'3,q.
Department of Environment, Health and Natural Resources
Division of Environmental Health
On -Site Wastewater Section
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
Owner: Applicant:
Address: Date Evaluated:
Proposed Facility: ` OJI ' Design Flow (.1949):3 C CK
Location of Site: Property Recorded:
Water Supply: ❑'P,, ublic❑ Individual ❑ Well
Evaluation Method&Ati Boring ❑ Pit ❑ Cut
Type of Wastewater: 4ewage ❑ 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
4�
C; Lni
Description Initial Repair System Other Factors (.1946):
System Site Classification (.1948): t
Available Space(. 1945) -1 Evaluated By: C` 1
System Type(s) ` -. Y Others Present:
Site LTAR �`