IPAC RHTE# 1 Li-s-3asac) Hari—tt County Department of Public 28002
Improvement Permit
A building permit cannot be issued with only an Improvemen ermit
PROPERTY LOCATION: Qc,C
ISSUED TO: i Co M5 -Sam e„ �sv C SUBDIVISIONQ t�.`�cro �.i , LOT #
NEV< REPAIR ❑N PA ION ❑
Type of Structure: '5 'FQ v`1'w�-1
Proposed Wastewater System Type: l ovc�: t c9
Projected Daily Flow: GPD Lt -60
Number of bedrooms: Number of Occupants: max
Basement ❑Yes >< No
Site Improvements required prior to Construction Authorization Issuance:
Pump Required: ❑Yes No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community 'k Public ❑ Well Distance from well 1 C*i Q feet Permit valid for: Five years
Permit conditio /❑ No expiration
Authorized State Agent:: Date: SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuanc other permits. The permit holde is responsi Ie for checking with appropriate governing bodies in meeting their requirements. This
site is subject to revocation if the site plan, plat, ort mten a anges. The rovement 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 eatm nt and Disposal a 7 . i
9—Gv
Construction orization
(Required for Building Permit)
The construction and installation requirements of Rules .1950, .1952, .1954, .1955, .1956, .1957, .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: Cc CCN C.\ QQ,S }-0 c. PROPERTY LOCATION: 0
;04A SUBDIVISION tq; LOT # \
Facility Type: New �) New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ Yes 25\No
V
Type of Wastewater System** a.S �G 7(,r•. (Initial) Wastewater Flow: GPD
(See note below, if applicable ❑) 9-60 u cas' 10 tv
S < EM (Repair)
Installation Requirements/Conditions® Number of trenches 1
Septic Tank Size "®gallons Exact length of each trench �e et Trench Spacing: 9 Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: 1 Q,, inches
Maximum Trench Depth of: a'--) 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 10FT. 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 on the application. / accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
This Construction Authorization is subject cation if to plan, plat, or the intended use changes. The Construction Authorization shall not he transferred when there is a change in ownership of the site. This
Construction Authorization is s to complian it t vise 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: )
action Authorization Expiration Date! _6 :DQ%7
HTE# Permit # M40-<�
arnett County Department ofti-blic Health
Site Sketch
PROPERTY LOCATON: C)oC's
ISSUED T0: �- g ALV C� 6Ct-5 ��G SUBDIVISION ()PAY—Vn010N LOT #
Authorized State Agent: S oi-wEq-'yoi-xss)O Date:
G�CGGU`f 1VL` Y� 6Z._