IPAC RHTE# +s°~~t 3C~ y. aritett County Department o lit ealth 25034
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: C- Le3--,~Z- IC C.AvtX~
ISSUED TO: SUBDIVISION JM I-N-4 Q) LOT # 16
NEW REPAIR ❑ nNSION El Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: S~9 ~1 5
Proposed Wastewater System Type: 'P~t.s-r--stow S-~sTFs~
Projected Daily flow: L"O GPD
Number of bedrooms: L-) Number of Occupants: max
Basement ❑Yes ',*K No
Pump Required: ❑Yes ❑ No May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well S®o feet Permit valid for: Five years
Permit conditions: _ ❑ No expiration
Authorized State Agent:: ® t1s
The issuance of this permit by the Health Department in no way guarantees t ce
site is subject to revocation if the site plan, plat, or the intended use changes. The Im
the Laws and Rules for Sewage Treatment and Disposal and to conditions of this permit..
Date: lc~19Ih1:2 SEE ATTACHED SITE SKETCH
of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This
vement Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of
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.
Far»L~1 Nd~6 Cd~a~~C
ISSUED TO: PROPERTY LOCATION: Ci.x\)(LC>A (~P
FQ ` ~ SUBDIVISION OOxs LOT #
Facility Type: New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ Yes No
Type of Wastewater System** a~la v C;'- +G N 5 ys-7 (Initial) Wastewater Flow: GIRD
(See note below, if applicable
/Ranairl
Installation Requirements/Conditions
Septic Tank Size ige) o gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
Number of trenches •4-
Exact length of each trench fa61 feet
Trenches shall be installed on contour at a
Maximum Trench Depth of: c3, inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
Trench Spacing: Feet on Center
Soil Cover: r- inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
inches below pipe
Aggregate Depth: inches above pipe
'5 sE inches total
**If applicable: /understand the system type specified is different from the type specified on the application. /accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
This Construction Authorization is subjec ovation if th 'te 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 compliant ' h visio of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent:
0-aN'8 16v)6))1
¢StciLive iaz Date: tc~ `z
structian Authorization Expiration Date: Lo
HTE# O~ aQ930 R- Permit # 21-S03
a05'
i
u,~su~~e'c3L~
\ 5 d\L
Division of Environmental Health Property ID:
On-site Wastewater Section Lot
File
SOIL/SITE EVALUATION Code:
for ON-SITE WASTEWATER SYSTEM
Owner: Applicant:
Address: Date Evaluated: tci~ b 1 w
Proposed Facility: 3- »ds ~ Design Flow (.1949): Property Size:
Location of Site: Property Recorded:
Water Supply: ~ublic (j Individual Well Spring Other
Evaluation Method: uger Boring Pit [ j Cut
Type of Wastewater: Sewage [ ] Industrial Process [)Mixed
P
R'
o
F
SOIL MORPHOLOGY
1941
OTHER
PROFILE FACTORS
1
L
E
#
1940
Landscape
Position/
Slope%
Horizon
Depth
(IN.)
1941
Structure/
Texture
A941
Consistence
Mineralogy
.1942 .
Soil •
Wetness/
Color
.1943
Soil
Depth (IN.)
,19,%
Sapro
Class
,1944
Restr
Honz
Profile
Class
& LTAR
6l
P~
5 .
~
lc~-3N
5A"-Sc..;_
~ DISC
1
Aca°)t} <1~L
3 '
~G
SAY sc
>
\01(Z
W-~ ~Ip
~s
V
~
Description
Initial ystem
Repair System
Available Space (,1945)
System Type(s)
C,
Site LTAR
3
yj
Other Factors (.1946): _
Site Classification (.1948):5
Evaluated By:
Others Present: