IPAC (2)HTE# 11-5 - MjHarnett County Department of Public Health
Improvement Permit 26801
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: n/1, s1 f u g
ISSUED TO:DIVISION LOT #
NEW ❑ REPAIR ❑ EXPANSIOV 12f Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: fX C%ft~-X41
Proposed Wastewater System Type: I$Vo t i)U aS
Projected Daily Flow: 5W - GPD
Number of bedrooms: - Number of Occupants: 180 max
Basement ❑Yes Z Nci
Pump Required: ❑Yes ❑ No Z Ma be required based on final location and elevations of facilities Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet Permit valid for: C7 hive years
Permit conditions: ❑ No expiration
Authorized State Age C_ l' Date: 1//' S=%/ SEE ATTACHED SITE SKETCH
The issuance of this permit by 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 i 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 TO:
" C 4N
11'1 1011 44x-,5PROPERTY LOCATION: -5~7t%? 91 , 2,•r~,7f i
SUBDIVISION
LOT #
Facility Type: r✓~ C
14_01 f
❑ New Z Expansion ❑ Repair
Basement? ❑ Yes Z
No Basement
Fixtures? ❑ Yes Z No
Type of Wastewater System**
2''I-1. tZ #
zt ~rt(fd~
(Initial) Wastewater Flow: GPD
(See note below, if applicable
rit,t,,,.
z Z`~~ sucrLcl~ (Repair)
Installation Requirements/Conditions
Number of trenches 3
Septic Tank Size Z Z00-
gallons
Exact length of each trench j&Q feet
Trench Spacing: Feet on Center
Pump Tank Size
gallons
Trenches shall be installed on contour at a
Soil Cover: jc inches
Maximum Trench Depth of: -Z142 - 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
G inches below pipe
Conditions:
Aggregate Depth:
inches above pipe
/Z 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 system type specified is different from the type specified on the application. l accept the specilcations 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. Jtt AI IACHtD Slit SKETCH
Authorized State A t: Date: fI !v - II
Construction Authorization Expiration Date: i I - I
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oq*dm=t of Emrito mcA Health and NOW Resources
Division of Rawmamcatni Health
Show.
On-Site Wastewater Section
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SOLUSITZ EVALUATION
File
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for ON-SITE WASTEWATER SYS~
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ode:
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Owaet: Applicant:
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D9dP Flow (.1949Y. 1'.04) prop
el Size:
Locatioli~sit«
Water ❑ individual ❑ Wen ❑ Spriag
Evduadon Me".
❑ Other
A gerBoring ❑ Pit Cd .
Type ofWaewater
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, wge ❑ kAmwal Process
Mixed
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P 30n. Uo"11OLMY
1 .1940
1941
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1942
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,1956 .1944 1'rotpi
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