IP R-ONLYHTE# I-�-5-L1T55GR Harnett County Department of Public Health 30038
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: NAyy w b �- ri, N s_
ISSUED TO: POLEr.)5N0,J CVs'COtc% "0^63 SUBDIVISION SurrarwwFJa,yr4 LOT # Ig
NEW4 REPAIR ❑ EK"�NSION ElSite Improvements required prior to Construction Authorization Issuance:
Type of Structure: (SO' �5x 4 $
Proposed Wastewater System Type: 15% RCn a COT s % t Sy,TE rr
Projected Daily Flow: 3ba GPD
Number of bedrooms: '3 Number of Occupants: max
Basement []Yes '5<No
Pump Required: ❑Yes '�K No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: El Community V Public ❑ Well Distance from well feet Permit valid for. >( Five years
Permit conditions: E r.a aE r F Ft -PSC. 6FJ� 'CJzw� N — a 6 z o Tp p2Gv6 � A eaY ❑ No expiration
Authorized State Agent:: �. �_� ' � Date: LA )� LI Ile
SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees race al other permit The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This
site is subject to eevoauon if the site plan, plat or de intended use changes. The Imp moment Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the previsions 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, .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 layouL
ISSUED TO
Facility Type:
Basement? ❑ Yes ❑ No
Type of Wastewater System" _
(See note below, if applicable ❑)
❑ New
Basement Fixtures? ❑ Yes
Installation Requirements/Conditions
Septic Tank Size gallons
Pump Tank Size gallons
PROPERTY LOCATION:
SUBDIVISION
❑ Expansion
❑ No
❑ Repair
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)
Pump Requirements: ft. TDH vs. GPM
Conditions:
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)
inches below pipe
Aggregate Depth: inches above pipe
inches total
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: / understand the sweet type specified it different from the type speriled on the application. / accept the rpecilcatiavr of this permit
Owner/Legal Representative Signature: Date:
This Construction Authodudon 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
Commission 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:
Date:
Construction Authorization Expiration Date: