IPACHTE#_ / -S-- RS--6 iL- -I- Harnett County Department of Public Health 2 61 8 9
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: 1,>~ r ~e K
ISSUED TO: / SUBDIVISION /~a .ti a r~ cv .rw~! LOT #
NEW G;r' REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: -57-F D
Proposed Wastewater System Type: _C4 iis~ri ~c~a
Projected Daily Flow: J GPD
Number of bedrooms: J Number of Occupants: t'- max
Basement ❑Yes Lilo
Pump Required: ❑Yes 1'1 No ❑ Ma be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
Permit conditions:
Permit valid for, 21-ive years
❑ No expiration
Authorized State Agent:: ~C Date: 2~ t d SEE ATTACHED SITE SKETCH
The issuance of this permit by the ealth Department in no way 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, 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: 4'6 &k -f
Facility Type: >5F-0 Er New
Basement? ❑ Yes No Basement Fixtures? ❑ Yes
Type of Wastewater System** C 0A&~4.c r
(See note below, if applicable
PROPERTY LOCATION: Xd.
SUBDIVISION f~~n Q-, r i LOT #
❑ Expansion ❑ Repair
❑ No
(Initial) Wastewater flow: -7 b GPD
C-t) ' lift C,' (Repair)
Installation Requirements/Conditions Number of trenches 0~
Septic Tank Size pz q gallons Exact length of each trench -,?d- feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of. -e ~ inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
Conditions:
&,J
c z' (ea.l
L inches below pipe
Depth: inches above pipe
_ f inches total
**If applicable: /under fond the system type specified is different from the type speciled on the application. /accept the fpeciIIcationt of t& permit.
Owner/legal Representative Signature:
This Construction Authorization is subject to revocation if the site plan, plat, or the intended use changes.
Date:
Construction Authorization shall not be transferred when there is a change in ownership of the site. This
Construction Authorization is subject to complian with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
C~
Authorized State Agent: Date: .55~1 2-
Construction Authorization Expiration Date:
Trench Spacing: q Feet on Center
Soil Cover Inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
HTE# / O-S- ?-rc J-
Permit # o? kz t F 5
Harnett (M rlty Department of I'iiblic Health
Site Sketeb
ISSUED TO: - /`ta y PROPERTY LOCATON: R F_t r~' I.
SUBDIVISION LOT #
Authorized State Agen X& / Date:
-7-C
fZ~
FMM,f cz"-"4
{division of Environmental Hewth
t n-site Wastewater Section
` SOII./SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
Owner.
Proposed Facility:
Location of Site:
Water Supply:
Evaluation Method:
Type of Wastewater:
Design Flow (.1949):
[ [ I Individual
~w
t,
['I Sewage
Property ID:
Lot #
File #
Code:
Applicant:
C
t
a
e Evaluated:
Property Size:
Property Recorded:
[IWd [I Sping
offler
[ I
I Pit [ I cut
[ I Industrial Process I I Mixed