IPAC REPAIRHTE# e.G?pa{L Harnett County Department of Public Health
&u t Lor -5- 3�Y552- Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION:
ISSUED TO
NEW ❑
REPAIR ❑
Type of Structure:
Proposed Wastewater System Type: _
Projected Daily Flow:
Number of bedrooms:
Basement ❑Yes
❑ No
Pump Required: []Yes
❑ No
Type of Water Supply:
❑ Community
Permit conditions: _
SUBDIVISION LOT #
EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
GPD
Number of Occupants: max
❑ May be required based on final location and elevations of facilities
❑ Public ❑ Well Distance from well feet
Permit valid for:
❑ Five years
❑ No expiration
Authorized State Agent: Date: SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate gumming 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 taws 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 arc incorporated by references into this permit and shall be met Systems shall be installed to auordance
with the attached system layout
ISSUED TO: Rysrhtri PROPERTY LOCATION:
Facility Type: AVTyn%QbLE QeQzh
Basement? ❑ Yes 'Nr No Basement fixtures?
Type of Wastewater System**
(See note below, if applicable 1-11
Installation Requirements/Conditions
Septic Tank Size t n f7 o gallons
Pump Tank Size gallons
Pump Requirements: ft. TON vs. _
Conditions:
SUBDIVISION
❑ New ❑ Expansion Repair
❑ Yes �DCNo
0.EC) U Gs it U >J Repair)
Number of trenches Z_
Exact length of each trench 9,CZ feet
Trenches shall be installed on contour at a
Maximum Trench Depth of.. Ig inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
LOT #
(Initial) Wastewater Flow: 160 GPD
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 ;pealed it different /rm the type speci(ed on the applicadon. / accept the speddcadom of this permit
Owner/Legal Representative Signature:
Construction Authorisation is
plat or the intended use changes. The Construction Authorization shah not be ancient
of the laws and Rules for Stone Treatment and Disoosal and to the conditions of this
Date:
Authorized State Agent: Date: 6 a 3 16
rstruction Authorization Expiration Date:
a change in ownership of the sire. This
SEE ATTACHED SITE SKETCH
HTE# JRFQ9N) CL_ Permit # Q-1,104
Harnett County Department of Public Health
Site Sketch
PROPERTY LO(ATON: 3oEt_ tn1 rsc,j V -D
ISSUED TO: R OSM M AabV 1 t_ SUBDIVISION j LOT #
Authorized State Agent: ShtiS `(tLyg6z—JoLx Do(&) Date: ��1311b
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