IPACHTE#Q7-5 - /77/l/ Harnw County Department of Public 'it,alth 23998
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
_ PROPERTY LOCATION:S/0/769 Uri) 577V -e .o /Zb
ISSUED TO- �P�F L } i hB2 SUBDIVISION / 7.2 a C %.r -ZC LOT #
NEW [ REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: Sf D
Proposed Wastewater System Type: 206 400,(,'-7M
Projected Daily Flow: MRO GPD
Number of bedrooms: —Ua— Number of Occupants: R max
Basement ❑Yes IQ No %
Pump Required: []Yes ❑ No f7J Maybe required based on final location and elevations of facilities
Type of Water Supply: ❑ Community fa Public ❑ Well Distance from well feet
Permit conditions:
Permit valid for:
01ive years
❑ No expiration
Authorized State Age Date: -7—d — O% SEE ATTACHED SITE SKETCH
The issuance of this perm the Health Department in no way 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
Reauired for Buildine Permit
The construction and installation requirements of Rules .19S0, .1952, .1954, .1955, .19S6, .1957, .19SR. and .1959 are incorporated by references into this permit and shall be met. Systems shall be
installed in accordance with the aaached system layout.
ISSUED TO: ,lL W �cJ%JCK PROPERTY LOCATION: 5V765 ei42 51-71ac,,E .et)
SUBDIVISION ®r-f'(X- LOT #
Facility Type: S F6 O New ❑lExpansion ❑ Repair
Basement? El Yes Yes No Basement Fixtures? ❑ Yes No
Type of Wastewater System" (Initial) Wastewater Flow: 5W! GPD
(See note below, if applicable ❑)
zgV, r-,42oio � (Repair)
Installation RequiremenWConditions
Septic Tank Size /ZW gallons
Pump Tank Size gallons
Pump Requirements: ft. TDA vs.
Conditions:
q X
Exact length of each trench 0y feet
Trenches shall be installed on contour at a
Maximum Trench Depth of: 1R-/9 inches
(trench bottoms shall be level to +/-1/4"
in all directions)
GPM
Trench Spacing: 7 Feet on Center
Soil Cover. inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
6 inches below pipe
Z inches above pipe
/ Z inches total
If applicable: /understand the ryJtem type specified it diNerent from the type specified ow the app/kation. / accept the specibrations of this permit.
Owner/Legal Representative Signature: Date:
This Construction Authorization is subject to revocation if the site plan, plat, or the intended use changes. The (onstmction 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.
A / SEE ATTACHED SITE SKETCH
Authorised State A etF ti.� �//�Aa✓Gi Date: 7-/3- &-7
Construction Authorization Expiration Date: 7 /3 - / L
HTE#�7-5 - /771 Permit # Z3Se13
Hai -Ilett County Department of Public Health
Site Sketch
PROPERTY LOCATON: yZ ZZZ OZ,-;) 577�.-.G PA
ISSUED TO: e,) SUBDIVISION #
Authorized State A�� � %s Date: -7' 13 — B%