IPACHTE# 0 30-Q 15 Harnett County Department of Public Health 2 5 2 3 4
hDrovement Permit
A building permit cannot be issued with only an Improv ent Permit
J PROPERTY LOCATION:
ISSUE T0: / t ~`t~~ SUBDIVISION Ft~'gci-T /)/I CS LOT #
NEWY REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: (7D - X \47 - '3 B (t
Proposed Wastewater System Type: M- .c
Projected Daily Flow: 3 (.off GPD
Number of bedrooms: _3 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: ❑ C mmunity Public ❑ Well Distance from well 3 feet Permit valid for -JZ Five years
Perm~}' -conditions: tF A, n r rs/ F~ At ki ❑ No expiration
U um iYt n evc A t' kvr- hc~c h 0 L4 /N .
Authorized State Agent:: ' 2 Date: C 4 "j SEE ATTACHED SITE SKETCH
The issuance of this permit by the H Ith 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
(Required for Building Permit)
The construction and installation requirements of Rules .1950, .1952, .1954, .1955, .1956, .1957, .19% 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: H PROPERTY LOCATIO : JZ
_ SUBDIVISION ) LOT # ~
Facility Type: ?J ><yl 39~ 16=1--New ❑ Expansion ❑ Repair
Basement? ❑ Yes tZ_ No Basement Fixtures? ❑ Yes No
Type of Wastewater System' '9f~A LeA~-c[t"n (Initial) Wastewater Flow: 363 GIRD
(See note below, if applicable t4) /
';jIDt (Repair)
Installation Requirements/Conditions Number of trenches
Septic Tank Size /ODD gallons Exact length of each trench 30 feet
Pump Tank Size gallons Trenches shall be installed on con our at
Maximum Trench Depth of: i hes
(Trench bottoms shall be level to +/-1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
Conditions:
Trench Spacing: ( Feet on Center
Soil Cover: ( inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
inches below pipe
Aggregate Depth: inches above pipe
inches total
**If applicable: l understand the system type specified is different from the type specified on the application. l accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
this Construction Authorization is subject to revocation it 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 AtllH
Authorized State Agent: Date: 0 (-d ~ -D 7
Construction Authorization Expiration Date: 0
HTE# COX S 0--,,) 13 Permit # 5d3`(
Harnett County Department of Pnblic Health
Site Sketch
/ PROPERTY LOCATON: 112j-
ISSUED TO: ! a~ SUBDIVISION r3 1WJ7QAfc. LOT #
Authorized State Agent: / Date: I
2(3
Tl
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ueparunent ul CIIVIIUIIIIICIII, nIddllli, d11U NdWldl MUb"IGeJ
Division of Environmental Health
On-site Wastewater Section
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
Owner:
Address:
Proposed Facility:
Location of Site:
Water Supply:
Evaluation Method:
Type of Wastewater:
Design Flow (.1949):
[ J Public [ j Individual
[ ]Auger Boring
[ j Sewage
V1 I-.
Property ID:
Lot
File
Code:
Applicant:
Date Evaluated:
Property Size:
Property Recorded:
[ J Well [ j Spring
[ j Pit [ j Cut
[ J Industrial Process [ j Mixed
[ I Other
P
R`
o
F
SOIL MORPHOLOGY
.1941`
O
PROFIL
THER
E FACTO
S
I.
L
E.
#
` .1940
Landscape
Position/; ,
Slope%
Horizon
Depth
(IN.)
1941
Structure/
Texture
.1941
Consistence
Mineralogy
.1942
Soil
Wetness/
Color
.1943
Soil
Depth (IN.)
.1956
Sapro
Class
.1944
Restr
Horiz
Pfofile{ ,
Class
a LTAR
L
t/~/~Ift- S•~.
.3
34, r/
JIM &
~ ?
mfr'' t~''
• t%'.
it j C-
-
fa
Description
Initial System
Repair System
Available Space (.1945)
System Type(s)
Site LTAR
Other Factors (.1946):
Site Classification (.1948): Q J
Evaluated By:
Others Present: