IPAC RHTE# �2� ' -34.1 v- Hari.ett County Department of Public dealth
Imurovement Permit 27409
A building permit cannot be issued with only an Improvement Permit
` PROPERTY LOCATION: \4
�Psy`ty 1�Oc�.CS �--�- v5vz
ISSUED T0: SUBDIVISION Yr-- ,S�As,1 n:5
LOT # (D
NEVI �REEPPAIR ❑ Ex gSIOjJ ❑ Site Improvements required prior to Construction Authorization Issuance:
t
Type of Structure:
Proposed Wastewater System T pe: � � / ® a Cny Tt O t J
�C'
Projected Daily Flow: GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes X.No
Pump Required: ❑Yes ❑ No May be required based on final location and elevations of facilities
Type of Water Supply: ❑ CommunityPublic ❑ Well Distance from well 100 feet Permit valid for:
Five years
Permit conditions: : n
❑ No expiration
Authorized State Agent:: Date: i SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no wa guarantees the issuance o ermits. The permit holder is res onsible for checking with appropriate governing bodies in meeting their requirements. This
site is subject to revocation if the site plan, plat, the inten an s. The Improvement Pe ' 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 Treatmentnd Disposa nditions
6L s 3 )k,� t 55 8115
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: RN `4-16°�^� PROPERTY LOCATION: \vIin_& (2-D
L-.rC) AA SUBDIVISION ��4,Q V�41+�J LOT # -5 0
Facility Type: � �K New ❑ Expansion ❑ Repair
Basement? ❑ Yes -'M No Basement Fixtures? ❑ Yes N
Type of Wastewater System** _ �.S" �(o � wcS } ON (Initial) Wastewater Flow: j J 0 GPD
(See note below, if applicable ❑)
�41
Installation Requirements/Conditions
Septic Tank Size t p 0 Q9 gallons
Pump Tank Size gallons
O JC `' ON (Repair)
Number of trenches I
Exact length of each trench ea140 feet Trench Spacing: Feet on Center
Trenches shall be installed on contour at a Soil Cover: C' inches
Maximum Trench Depth of: I�--ZQ 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 inches below pipe
Aggregate Depth: inches above pipe
Conditions:Zi� 6' S C,Nd) 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 specired is different from the type specired on the application. / accept the speciTcations of this permit.
Owner/Legal Representative Signature: Date:
This Construction Authorization is subjectTorevgsation if the site pin, plat, or the intended use changes. The Construction Authorization shall not be transferred when there is a chanee in ownership of the site. This
Construction Authorization is subi� compliance wii1 io iM�ws and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Date: 3
Authorization Expiration Date: ` 3
HTE # Permit #
Rcarnett County Department of Miblic He(-I;Itll
Site Sketch
PROPERTY LOCATON:
ISSUED TO- SUBDIVISION LOT
Authorized State A Date:
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19
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