IPAC(c;, _ S"° 3L r 4f L C-
HTE# r9 Harnett County Department of Public Health
Improvement Permit 2 6 3 0 8
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: Gr-r 4971 kl
ISSUED TO:. j-- It SUBDIVISION LOT #
NEW REPAIR ❑ EXPANSION ❑
Type of Structure: 0 C `/X 71
Proposed Wastewater System T pe: s~S65!~ 4<-[
Projected Daily Flow: GPD
Number of bedrooms: Number of Occupants: UG max
Basement ❑Yes No
Site Improvements required prior to Construction Authorization Issuance:
Pump Required: ❑Yes ❑ No LT Ma be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community (Public ❑ Well Distance from well feet
Permit conditions:
f"Five years
❑ No expiration
Authorized State Agent:: se. cam , Date: 7/a-J/ m SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in~noCway 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, .1951, .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 T0: PROPERTY LOCATION: C-.~-,'e
SUBDIVISION LOT #
Facility Type: d f 0"N ew ❑ Expansion ❑ Repair
Basement? ❑ Yes Rr" No Basement Fixtures? ❑ Yes ❑ No
Type of Wastewater System**rf4 (Initial) Wastewater Flow:j GPD
(See note below, if applicable
ee (Repair)
Q'M Installation Requirements/Conditions Number of trenches /
Septic Tank Size A00 gallons Exact length of each trench feet Trench Spacing: Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: f inches
Maximum Trench Depth of: -c inches (Maximum soil cover shall not exceed
(Trench bottoms shall be level to +/-1/4" 36" above the trench bottom)
in all directions)
Pump Requirements: ft. TDH vs. GPM inches below pipe
g~ Aggregate Depth: inches above pipe
Conditions: k _ ww C_' '5 f - inches total
i
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: l understand the system type specified is different from the type specified on the application. l accept the spec/lcations of this perm/t.
Owner/Legal Representative Signature: Date:
Thic rnnstnirtinn Authorization is subject to revocation if the site olan. 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 Agent: d ` -ti's Date: C T Xza,
Construction Authorization Expiration Date: B ttf ('1J"
Permit valid for:
HTE# / Permit # aoos
Harnett County Department of Public Health
Site Sketch
PROPERTY LOCATON:
ISSUED TO: ~ Aur- ° ~ SUBDIVISION LOT #
ll 7 7(2'"0
Authorized State Agent: A", Date:
r30,
Department of Environment, Health and Natural Resources
Division of Environmental Health
On-Site Wastewater Section
SORJSITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
Owner: Applicant: /
Address: Date Evaluated: 4111 0
Proposed Facility: Design Flow (.1949):
Location of Site: Property Recorded:
Water Supply: [Public ❑ Individual ❑ Well
Evaluation Method: Auger Boring ❑ Pit ❑
Type of Wastewater: Sewage ❑ Industrial Process ❑
Sheet:
Property ID:
Lot
File
Code:
Property Size:
❑ Spring ❑ Other
Cut
Mixed
P
R
O
F
I
1940
OIL MORPHOLOGY
.1941
THER
PROFILE FACTORS
L
E
#
Landscape
Position/
Slope %
Horizon
Depth
(In.)
.1941
Structure/
Texture
.1941
Consistence
Mineralogy
.1942
Soil
Wetness/
Color
.1943
Soil
Deptli IN.
.1936
Sapro
Class
.1944
Restr
Horiz
Profile
Class
& LTAR
t~ q
~
fdb
K /0
Description
Initial
system
Repair System
Other Factors (.1946):
Site Classification (.1948):
Available Space .1943
Evaluated B
~
System Ty~s)
4
p
`
Others Present: :
Site LTAR
/
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