IP ONLY NO AUTHORIZATION TO CONSTRUCTHTE# Icy s ~-A Harnett County Department of Public Health
Improvement Permit 2 6 2 3 9
A building permit cannot be issued with only an Improvement Pe it
PROPERTY LOCATION: !-lwy ~o
ISSUED T0: SUBDIVISION -i ~,4GG_,, PO LOT #
NEW ~J REPAIR ❑ EX!1ION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: SFQ LSO ~ 4-~0, to
Proposed Wastewater System Type: a~°lo fL~.w~:~o 14
Sv c
Projected Daily Flow: 5(,O GPD (~)N ~aoP05P,L C-~_r d<=~'
Number of bedrooms: Number of Occupants: C, max Basement ❑Yes XNo QCLP,\-_i V\GL-'o ~ ca \-Y2pt`r• ~LL , fLQ,F~~~
Pump Required: ❑Yes ❑ No ',May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community 'LR~ Public ❑ Well Distance from well 's b0 feet Permit valid for. Five years
Permit conditions: ❑ No expiration
Authorized State Agent.: Date: q I I6I 1Z SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the iss f 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 Improves ent 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:
Facility Type:
Basement? ❑ Yes ❑ No
Type of Wastewater System** _
(See note below, if applicable
(Repair)
Installa6cin Requirements/Conditions Number of trenches
Septic Tank Size gallons Exact length of each trench feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of. inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
Conditions:
LOT #
(Initial) Wastewater flow: GPD
Trench Spacing: Feet on Center
Soil Cover inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
inches below pipe
inches above pipe
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 app/station. /accept the tpeciTcationr of thi 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
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
❑ New
Basement Fixtures? ❑ Yes
PROPERTY LOCATION:
SUBDIVISION
❑ Expansion ❑
❑ No
Repair
Authorized State Agent: Date: _
Construction Authorization Expiration Date: