IPAC RHTE#X-s-3I EQ 1 Q� arr.,,t County Department of Public'.realth
Improvement Permit 27543
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: �L)cv�- C'� ChfiZ2sclsv �j
ISSUED TO:-(Ngx)ley 40 SUBDIVISION LOT #
NEWT REPAIR ❑ EXPANSION . Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: t" 1 P%,-3 1A 0 r F_ �nZ`+Z J
Proposed Wastewater System Type: 9-,5°3v T2_GroQ 1 e *J
Projected Daily Flow: 36 ® GPD
Number of bedrooms: -3 Number of Occupants: max
Basement ❑Yes X No
Pump Required: ❑Yes No ❑ Ma be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public Distance from well 100 feet Permit valid for: Five years
Permit conditions: _ d ❑ No expiration
Authorized State Agent:: Date: -?I 1 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the isc 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 cha e e ermit 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 Disposaland to c this p
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: �At2&t-o Nkof 0 PROPERTY LOCATION: _ �J�N' C� c� CK22�0I'J 'R'
SUBDIVISION LOT #
Facility Type: rl t'�aa 1�om� J New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ Yes XNo
Type of Wastewater System** e1G n -u3 oc.�' o >v /Z>' CV"' (Initial) Wastewater Flow: Co_0 GPD
(See note below, if applicable ❑)
'Rcs�' V L; � C) N (Repair)
Installation Requirements/Conditions Number of trenches
Septic Tank Size gallons Exact length of each trench S feet Trench Spacing: Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: G 'l 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 inches below pipe
Aggregate Depth: inches above pipe
Conditions: inches total
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.
*If applicable: /understand the system type specified is different from the type specified ofl the application. / accept the specifications of this permit.
Owner/Legal Representative I Date:
This Construction Authorization is subject to revocatio i�Ia�,�orthe intended use changes. The Construction Authorization shall not be transferred when there is a change in ownership of the site. This
Construction Authorization . compliant 'th d Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Date: 8
Construction,orization Expiration Date:
HTE# Q- Permit # -2`)G L' 3
Haxnett County Department of Public He(,tltl-i
Site Sketch
PROPERTY lf)fATnMo V�-1211—k
ISSUED TO:
Authorized State Agent:
"I
SUBDIVISION
LOT
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