IPAC RRHTE# IS' 5-"63`1RC— Harnett County Department of Public Health 28769
hDrovement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: \41na6r-p' on C)(L
ISSUED TO: r, A4 UM Eg SUBDIVISION L LOT # Oo 4
NEW LN' REPAIR ❑ EKP�NSION ❑ Site Improvements required prior to Construction Authorization Issp�nce:
Type of Structure: 520 �3�'^�' J -"J ( .y. USt�� sE,y Waa.,,. NG6a o 6 1.oGAT —
Proposed Wastewater System Type: Ov "*To aG t r
Projected Daily Flow: 36 O GPD ��a" V04141 coq-" r), OF 1.4% �0
Number of bedrooms: 3 Number of Occupants: C,, max r
Basement ❑Yes 'WNo 9 )O OCL r. 0tt2,Ec.SLV �\MRCSa-"
Pump Required: lR es ❑ No
Type of Water Supply: ❑ Community
Permit conditions:
❑ May be required based on final location and elevations of facilities -T0 P2V9F,=''y 1---N44E
Public ❑ Well Distance from well lb feet Permit valid for. Five years
❑ No expiration
Authorized State Agent: QG=iS Date: 31 X21 1 b SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way gumantees the ismanc er permit. The permit holde�ibk 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 1 shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of
the laws add Rules for Sewage Tremment and Disposal and to conditions of this permit.
Construction Authorization
(Required for Building Permit)
The constriction 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 xcordance
With the attached system layout.
ISSUED TO: PROPERTY LOCATION:
SUBDIVISION LOT #
Facility Type: ❑ New ❑ Expansion ❑ Repair
Basement? ❑ Yes ❑ No Basement Fixtures? ❑ Yes ❑ No
Type of Wastewater System" (Initial) Wastewater Flow: GPD
(See note below, if applicable ❑)
(Repair)
Installation 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
Pump Requirements: ft. TDH vs.
Conditions:
Maximum Trench Depth of: inches
(Trench bottoms shall be level to +/•1/4"
in all directions)
GPM
Trench Spacing: Feet on Center
Soil Cover: inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
inches below pipe
Aggregate Depth: inches above pipe
inches total
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.
""If applicable: / understand the system type spedffed it different from the type spedhed on the app/kation. / accept the sped/cadons of this permit
Owner/Legal Representative Signature: Date:
This Construction Authorization is subject to revocation if the sit 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 SewaRe Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State Agent:
Date:
Construction Authorization Expiration Date:
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: 1
Proposed Facility: Li Go�zk _' Design Flow (.1949):
Location of Site: Property Recorded:
Water Supply: Public❑ Individual ❑ Well
Evaluation Method Auger Boring ❑ Pit ❑ Cut
Type of Wastewater: N�C❑ Sewage ❑Industrial Process
Sheet:
Property ID:
Lot #:
File #:
Code:
Property Size:
❑ Spring
❑ Mixed
❑ Other
P
R
O
F
1
L
E
#
.1940
landscape
Position/
Slope%
Horizon
Depth
(In.)
SOIL MORPHOLOGY
.1941
OTHER
PROFILE FACTORS
Profile
Class
& LTAR
.1941
Structure/
Texture
.1941
Consistence
Mineralogy
.1942
Soil
wetness/
Color
.1943
Soil
Depth IN.
.1956
Sapm
Class
.1944
Restr
Horiz
,e 3"
�5
a
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rn)p ,'ylQ 36
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US
Description Initial Repair System Other Factors (.1946):
System Site Classification (.1948):
Available Space(. 1945) Evaluated By:
System Type(s) Others Present:
Site LTAR