IPACHTE# 1o-s-QgT,72_ Harnett County Department of Public Health 2 61 8 2
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
} PROPERTY LOCATION: leo
ISSUED T : cu1Cf ~~~ft /topsf SUBDIVISION LOT #
NEW REP IR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: -~bV✓ A a 8 66,
Proposed Wastewater System Type:
Projected Daily Flow: GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes -No -
Pump Required: ❑Yes ❑ No C / a be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community 7 public ❑ Well Distance from well feet Permit valid for glive years
Permit conditions: ❑ No expiration
Authorized State Agent.: A-1 - , ' Date: zC'l0
SEE ATTACHED SITE SKETCH
The issuance of this permit by a Health Dep tment in now guarantees the issuance of 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 changes. The Improvement 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: "iec"Ay el r- 7k f"- PROPERTY LOCATION: Cr,
Facility Type: V New
Basement? ❑ Yes No Baseme t Fixtu es? ❑ Y
Type of Wastewater System" C cam. (ems.
(See note below if a I; bl ❑
SUBDIVISION
❑ Expansion ❑
❑ No
Repair
LOT #
(Initial) Wastewater Flow: S LG
pp Ica e )
C°r,,,re,,4, (Repair)
Installation Requirements/Conditions Number of trenches
Septic Tank Size f OC? 0 gallons Exact length of each trench feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of: Q _O =CZ inches
(Trench bottoms shall be level to +1-114"
in all directions)
Pump Requirements: ft. TDH vs. GPM
itions- 4-c-r`"C` 4: " Ci -~-4 czo
**If applicable: /understand the system type specified /s different from the type specified on the
c-,- r a.lre
-eJkC I'
/ accept the rpecilwions 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 change in ownership of the site. This
Construction Authorization is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Trench Spacing: 9 Feet on Center
Soil Cover: (-,-12- inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
GPD
inches below pipe
inches above pipe
inches total
Aggregate Depth:
Authorized State Agent: Date: 1clu
Construction Authorization Expiration Date: i3 `0
HTE# s a ?
Permit # a2 ~ I e, I
Harnett ('ounty Department of Public Health
Site Sketch
PROPERTY LOCATON:
ISSUED T0: g 11, use 7~c~q,~` SUBDIVISION LOT #
Authorized State Agent Date: 2-4 0
C l
1
as°I
a
Department of Euvironmenk Health and Natural Reso.,,,
Division of Environmentd He
lth
Shed:
a
On-Site Wastewater Section
Property ID:
Lot 0:
SOUJSIITZ EVALUATION
File il.
for ON-SITE WASTEWATICS SYSTEX
Code:
Owner: Applicant:
Addrem Date Evaluated:
Pop°ed Facility: Design Flow (.1949):
Locadon o[ Sites Property Eteoorded:
Property Size:
Watet Snppit C1 lmod
Evaluation Method D rdvduat ❑ Well Auger Honing ❑ Pit
c
❑ Spring ❑ Other
ut
Type of Wastewater: Sewage ❑ Industrial Process M
ixed
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.1940
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Evahated Br.