IP-ONLYHTE# 10- 3"11360`4 Harnett County Department of Public Health 29924
ImDrovement Permit
A building permit cannot be issued with only an Improvement Permit
-T� PROPERTY LOCATION: YVlT2 1 art CL;v2 cik aka 52 l553�
ISSUED TO• ,oenni(W _JC4r bn 15JP%&y kk-,,sem SUBDIVISION LOT # 55
NEW Q� REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: zi62 3oaX�n' �Mbl
Proposed Wastewater System Type: a656 2c,2szlx,rn 5.5 .
Projected Daily Flow: f � GPD ✓
Number of bedrooms: Number of Occupants: Amax
Basement ❑Yes o /'
Pump Required: ❑Yes ❑ No C4'May b red based on final location and elevations of facilities
Type of Water Supply: ❑ Community ublic ❑ Well Distance from well r—' Pt feet Permit valid for.1v� years
Permit conditions: ❑ No expiration
L 4-- \\ iwo r\o,,a .a t— r — -. i_.. I :_.. A..1 1 _ _.__ v _
Authorized State Agent:: Date: 03 I Q /.;Io/g SEE ATFACHED SITE SKETCH
The issuance of this permit by 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 requirement. 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 commiction and installation requirement of Rules .1950, .1953, .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:
Facility Type:
Basement? ❑ Yes ❑ No
Type of Wastewater System" _
(See note below, if applicable ❑)
PROPERTY LOCATION:
SUBDIVISION
❑ New ❑ Expansion C
Basement Fixtures? ❑ Yes ❑ No
Installation Requirements/Conditions
Septic Tank Size gallons
Pump Tank Size gallons
Pump Requirements: ft. TON vs.
Conditions:
Number of trenches
Exact length of each trench
Trenches shall be installed on contour at a
Maximum Trench Depth of:
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
Repair
LOT #
(Initial) Wastewater Flow: GPD
feet Trench Spacing Feet on Center
Soil Cover: inches
inches (Maximum soil cover shall not exceed
36' above the trench bottom)
Aggregate Depth:
WATER LINES (INCLUDING IRRIGATION) MUST BE ]OFT. 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: / undeatand the system type specified is different from the type specified can the app/kation. / accept the rpeciffrwions 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 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:
Construction Authorization
Date:
ltion Date: