IPACHarnett r Department of Public Health
J
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
�jPROPERTY LOCATION: t& tv ('%\a E
ISSUED TO: c. 0 LIL SUBDIVISION LOT #'i��_
NEW REPAIR ❑ E4PANSION Site Improvements required prior to Construction Authorization Issuance:
Type of Structure:
Proposed Wastewater System Type: VZO c1C,— o.► sty
Projected Daily Flow: 4 6 GPD
Number of bedrooms: LA" Number of Occupants: max
Basement ❑Yes XNo
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 160 feet Permit valid for. Five years
Permit conditions: A ❑ No expiration
Authorized State Agent:: � � \ fs �_ Date: y ii 1—y7I-A SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the i c f other permits. The permit hold 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 Improv 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: IV) Ly—c—, mc, 5 L -C- PROPERTY LOCATION:
SUBDIVISION�s� 0. LOT # `, '-I
Facility Type: s� 1rx �� New ❑ Expansion ❑ Repair
Basement? El Yes No Basement Fixtur s? El Yes XNo
Type of Wastewater System** 1 CT 0 yZ 7:.. +-C\ (Initial) Wastewater Flow: GPD
(See note below, if applicable ❑)
r+'' 1 '� )ci (Repair)
Installation Retirements/Conditions Number of trenches Cv
Septic Tank Size ► 0 (00 gallons Exact length of each trench C) feet Trench Spacing: �� Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: inches
Maximum Trench Depth of: i <i 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 ]OFT. 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: l understand the system type specified is different from t4e type speciped on the application. / accept the specifIcations of this permit.
Owner/Legal Representative Signature: Date:
This Construction 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 chance in ownership of the site. This
Construction Authorization is o compliant^.*,I,':'th-e tovisions 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: T:'
Constr ' n Authorization Expiration Date: )11
HTE# 1 J —5" `% Permit # a-163)5
Harnett County Department of niblic Health
Site Sketch
PROPERTY LOCATON:
ISSUED T0: ��— " `�"�� �--�—� SUBDIVISION LOT #
Authorized State Agent:
jd1s`te:
�—r
F. LC i &1 0 62AIt44
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: Gr-DA'r\ Design Flow(. 1949): 4'0:O
Location of Site: Property Recorded:
Water Supply: Public❑ Individual ❑ Well
Evaluation Method:t&Auger Boring ❑ Pit ❑ Cut
Type of Wastewater: 15 Sewage ❑ Industrial Process
Sheet:
Property ID:
Lot #:
File #:
Code:
Property Size:
❑ Spring
❑ Mixed
❑ Other
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
D th (IN.)
.1956
Sapro
Class
.1944
Restr
Horiz
L5
114-36
sg� G
SIS
�SgS
O 3(�
5V_
4 y
36
Pt�,
�L
Description Initial Re air System Other Factors (.1946):
S ste Site Classification (.1948):
Available Space (.1945) Evaluated By:(_�
System Type(s) s o U ( Others Present:
Site LTAR S
C , ca e )$ ,