IPAC RHTE# I6-5- 4ci) .6Z Harnett County Department of Public Health 29143
Improvement Permit
A building permit cannot be issued with only an Improv�"ent Permit t�
PROPERTY LOCATION: a.1� WN+11U20(l1 F1Jq
ISSUED TO: J 01 k -',-e t ;-"'i "Q0 Glc. SUBDIVISION Dor„ AAg2004 LOT #
NEW ❑ REPAIR ❑ EXPANSION 'IV Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: -, S'Z�^,..��
�.(Q/ORv6 V r_
Proposed Wastewater System: e� ea ��OV ,I atJ
Projected Daily Flow: "AlA Q GPD
Number of bedrooms: _1_1� Number of Occupants: CE max
Basement ❑Yes No
Pump Required: ❑Yes No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community '5Z Public ❑ Well Distance from well NO(S feet Permit valid for. 114ive years
Permit conditions: _ ❑ No expiration
Authorized State Agent:: 74`m� Date: �_1aS �l SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the I ats�e of other permi s. The permit hod er i� for checking with appropriate governing bodies in meeting their requirements. This
site is subject m revocation if the site plan, pla4 or the intended use changes. The Impro menu Permit shall not be affected by a change in ownership of the site. This permit is subject on 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 .1958, .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: M .scLf30Z;)4 PROPERTY LOCATION: _D -,NN " oO*) 162002( Q d W
SUBDIVISION LOT # �l
Facility Type: H5" sat" ❑ New �SK\ Expansion ❑ Repair
Basement? ❑ Yes 'E;k No Basement Fixtures? ❑ Yes 'N(No
Type of Wastewater System" a S°(o n F pU GST 0 N (Initial) Wastewater Flow: S` S GPD
(See note below, if applicable ❑)
L—e a (Repair)
Installation Requirements/Conditions Number of trenches I
Septic Tank Size & s t^a 6. gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Exact length of each trench -IS feet
Trenches shall be installed on contour at a
Maximum Trench Depth of: N`b inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
Trench Spacing: Feet on (enter
Soil Cover. 6 inches
(Maximum soil cover shall not exceed
36' above the trench bottom)
Aggregate Depth:
Condition: P0Q Or+6 Y-1NQ-7-0 S-,45tvtic, Sy 5T
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.
inches below pipe
inches above pipe
inches total
**If applicable: / andeataad the grtem type Whiled /r different from the type speciled on the app/icadom / accept the rpecilcatioar of this permit
Owner/legal Representative Signature: Date
This Construction Autlwriaatian is subj vonfion if the site plan, plat, or the intended use changes. The construction Authorisation shall not be transferred when there is a change in ownership of the site. this
construction Authorization is soh t m mmplian t "'ons of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State Agent: N6 Date: S "T
Ntruction Authorization Expiration Date: I
HTE# Permit # 8`gS1Y3
Harnett County Department of Public Health
Site Sketch
PROPERTY LO(ATON: a>\ �)0NN-ibQp0,L Zol)
ISSUED T0: �� �S VCLGOG>C r SUBDIVISION LOT #
Authorized State Agent: Date: T, o
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