IPACHTE 0 S Harnett County Department of Public Health 2
• J
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
r -
PROPERTY LOCATION: Ca2,'1�
ISSUED TO: -'10 r'1C-f � C- SUBDIVISION LOT # t
NEW,, ` REPAIR � EXP ION El
Type of Structure: SV� S � �
Proposed Wastewater System Type: -4 S 0/, - 'icr, 1 ujo
Projected Daily Flow: ® GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes No
Site Improvements required prior to Construction Authorization Issuance:
Pump Required: ❑Yes K No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 700 feet
Permit conditions:
Authorized State Agent:: QL;`
The issuance of this permit by the Health Department in no way guarantee the i nce
site is subject to revocation if the site plan, plat, or the intended use changes. The Imp
the Laws and Rules for Sewage Treatment and Disposal and to conditions of this permit..
Permit valid for:
Five years
❑ No expiration
0 Date: 3 I- SEE ATTACHED SITE SKETCH
of other permits. The permit hold r is res onsible for checking with appropriate governing bodies in meeting their requirements. This
eRzent Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of
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: L ---i orf �� �-� G �S �G PROPERTY LOCATION:
- SUBDIVISION `— LOT # '—A
Facility Type: New ❑ Expansion ❑ Repair
Basement? ❑ Yes 1 No Basement/ Fjxture 1 ❑ Yes No
Type of Wastewater System** �- C(G s d� G� (Initial) Wastewater Flow: GPD
(See note below, if applicable ❑)
-V Lt -gym � 70 1 (Repair)
Installation Requirements/Conditions Number of trenches
Septic Tank Size 10 C=Do gallons Exact length of each trench feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of. i �` a` inches
Pump Requirements: ft. TDH vs.
Conditions:
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
Trench Spacing: Feet on Center
Soil Cover: C', -Ja 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 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 subjeef tc revocation if the site Plan, Plat or the intended use changes. The Construction Authorization shall not he transferred when thAm k a Ann - in —narchfn f t6 dt• rhf�
Construction Authorization is su o compliance a provisi 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: -31ll'�
truction Authorization Expiration Date: d ' d
HTE#
Permit #
CountyHarnett 11 •nt of Public Health
Site Sketch
PROPERTY LOCATON:
ISSUED TO: �1� �' v ��=it 1 N U SUBDIVISION `"' LOT # --ft-
Authorized State Agent: ��'�� 5 et- Date: 7� ) I ? _
�
Department of Environment, Health and Natural Resources Sheet:
Division of Environmental Health Property ID:
On -Site Wastewater Section Lot #:
File #:
SOIL/SITE EVALUATION Code:
for ON-SITE WASTEWATER SYSTEM
Owner: Applicant:
Address: Date Evaluated:
Proposed Facility: Design Flow (.1949)x, jQ� Property Size:
Location of Site: Property Recorded:
Water Supply: Public❑ Individual ❑ Well ❑ Spring ❑ Other
Evaluation Method: Auger Boring El pit ❑ Cut
Type of Wastewater: _N11Sewage ElIndustrial Process ElMixed
e
P
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L
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#
.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
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Description Initia Repair System Other Factors (.1946):
Syste Site Classification (.1948):
Available Space (.1945) V Evaluated By: G�
System Type(s) J V Others Present:
Site LTAR