IPACHTE# /o -s- rssz 7 Harnett County Department of Public Health 6 Q 8 7
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
ISSUED T PROPERTY LOCATIOksEe ! OC4
NEW REPAIR El SUBDIVISION 6,14 LOT #
EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: n/01W"' 'XC'6
Proposed Wastewater System Type: C40 Gf-1,077,j: 4--11
Projected Daily Flow: _ U GPD
Number of bedrooms: Number of Occupants:
Basement []Yes 4 No max
Pump Required: ❑Yes ❑ No Ltf MM e required bWd on final location and elevations of facilities
Type of Water Supply: ❑ Community Public Y Well Distance from well 140
Permit conditions: feet Permit valid for. Lv7 Five years
❑ No expiration
Authorized State A
Date: /Q : 47 - /r) SEE ATTACHED SITE SKETCH
The issuance of this permit Health Department in no way guarantees the issua ce 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 the art attachethed syandstem installation layout. requirements of Roles .1950, .1952, .1954, .1955, .1956, .1957, .1958. and .1959 are incorporated by references into this permit and shall be met Systems shall be instalkd in accordance
with the
ISSUED T0:
lole PROPERTY LOCATION: dV~
Facility Type: EkJ SUBDIVISION LOT # /
/New Expansion ❑ Repair T--
Basement? ❑ Yes No Basement Fixtures? ❑ Yes Ce No
Type of Wastewater System*" ceA) it rj
(See note below, if applicable (Initial) Wastewater Flow: GPD
RL''* &&-)
a (Repair)
Installation Requirements/Conditions Number of trenches
Septic Tank Size _<V6 gallons Exact length of each trench _ /ZD feet
Pump Tank Size ?t gallons Trenches shall be installed on contour at a
r^lon- Maximum Trench Depth of. inches
(Trench bottoms shall be level to +/-1/4"
Pump Requirements: in all directions)
ft. TDH vs. GPM
Conditions:
Trench Spacing:_ Feet on Center
Soil Cover inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
(e inches below pipe
Aggregate Depth: Z inches above pipe
inches total
""If applicable: / understand the system type specified /s different from the type soecided on the app/ication. / accept the soeci6cationr of this permit.
Owner/Legal Representative Signature:
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 subject 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
Authorized State Ag •
Date:
Construction Authorization Expiration Date:
HTE# Permit # __,7 /p $ 7
Harnett County Department of Public Health
Site Sketch
PROPERTY LO(ATON; 5,Z 5,3, ~1,orK C~ ~S
ISSUED T0: ,~~4Z~/ SUBDIVISIONS/~C
LOT #
Authorized State A nt.
Date: /D - Z7 - /p
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Dep~neonft~Emma, Health and Naturd Resoum" Sheet:
amental Health
On-Site wastewater section Property ID:
Lot M:
SOQJSrR (VALUATION File M:
for ON-SITz wmuwAmm SY9Tm Code:
Owner. Applic~% y- ~0
Addt Da &Wuatai. 16' l5" ' t~ "
Proposed Fa~clllty: Desip Ftow (.1949r p
Wat uppi(~ Z prop" 1?~eoorded ~ V Size
Evaluation D Individual 0 feu ❑ s
Method: ❑ p
r Boring
&LIPP g ❑ Other
Type of Wastawater: ❑ indu Wai Pro=m Mud
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1 .1940 OTHER
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