IPACImprovement Permit
A building permit cannot be issued with only an Improvement Permit
_ PROPERTY LOCATION: 0014 16gP 6.1
ISSUED T0:-'xrESi �C�.'CvC�]— Sf�� SUBDIVISION LOT #
NEWX REPAIR ❑ PANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: `�Q:I�kO�x 1 c
Proposed Wastewater System Type: a-S7o �-, LGN
Projected Daily Flow: f— GPD
Number of bedrooms: 3 Number of Occupants: max
Basement ❑Yes >< No
Pump Required: ❑Yes 7�<No ❑ May be required based on final location and elevations of facilities It
Type of Water Supply: El Community 'X Public El Well Distance from well e b O feet Permit valid for: Five years
Permit conditions: ._ ❑ No expiration
Authorized State Agent:: Date: `A SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the iss other permits. The permit hol er 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 lmpro—ye—mtht 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.
1
ISSUED TO: Q -Q— PROPERTY LOCATION: + li)o Lam
SUBDIVISION �------ LOT # �
Facility Type: C�'-� )< New ❑ Expansion ❑ Repair
Basement? ❑ Yes 'k No Basement Fixtures? ❑ Yes LNo
Type of Wastewater System" a.5et o —yG;� s d.k'a C_tcN (Initial) Wastewater Flow: � -P GPD
(See note below, if applicable ❑)
Jc EZvcr% Q SJ (Repair)
Installation Requirements/Conditions Number of trenches d
Septic Tank Size earJ gallons Exact length of each trench
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of: A "2�Ll
Pump Requirements: ft. TDH vs.
Conditions:
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
feet Trench Spacing: cl Feet on Center
Soil Cover: Cinches
inches (Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
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.
inches below pipe
inches above pipe
inches total
**If applicable: /understand the ystem type specified is different from the type specifled on the application. / accept the speciTcations of this permit.
Owner/Legal Representative Si nature: Date:
This Construction Authorization is subject tore ion if a 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
Construction Authorization is su ' to compliae th t v ' 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: 8
on Authorization Expiration Date: '�,O
-1
Permit # a��Scj
HTE#
arnett County I)epartment of Public Health
H
Site Sketch
PROPERTY LOCATON: LOT #
SUBDIVISION
ISSUED TO-
ate:
Authorized State Agent: 4 1 1
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: Design Flow (.1949):36( A u
Location of Site: Property Recorded:
Water Supply:Public❑ Individual ❑ Well
Evaluation Metho Auger Boring ❑ Pit ❑ Cut
Type of Wastewater: Isewage ❑ 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/
.1941
Consistence
Mineralogy
.1942
Soil
Wetness/
Color
.1943
Soil
Depth (IN.)
.1956
Sapro
Class
.1944
Restr
Horiz
hTexture
iG3�
1 l
Description Initial Re air System Other Factors (.1946):
System/ Site Classification (.1948): s
Available Space(. 1945)Evaluated By:
System T e(s) p' >G
-CD
Others Present:
Site LTAR jk