IPACHTE# Harnett County Department of Public Health
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
� } PROPERTY LOCATION: C)c:) c,5 90
ISSUED TO: t-Tt f aaat-lSC -w C.X �N SUBDIVISION `7® )N QZ, R .:N0e- I. LOT #
NEW'K REPAIJi ❑ )XPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: c'l�o t � "G--J
Proposed Wastewater System Ty r')-E;-T0 r')-E;-T0 DU(^1 ON
Projected Daily Flow: "16 o GPD
Number of bedrooms: `A Number of Occupants: max
Basement ❑Yes �R No
Pump Required: ❑Yes -*�K No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ @mmuwijt `�< Public ❑ Well Distance from well 1.110 feet Permit valid for: , `Five years
Permit conditions: ., a ❑ No expiration
Authorized State Agent:
The issuance of this permit by the Health Department in no way guarantees the issu
site is subject to revocation if the site plan, plat, or the intended use changes. The Improvement
the Laws and Rules for Sewage Treatment and Disposal and to conditions of this permit..
Date:
SEE ATTACHED SITE SKETCH
s. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This
shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of
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: `AyN314 C-10 ���d N lb„C , PROPERTY LOCATION: pots ,
SUBDIVISION 1 rzcm( -8.5 ?-, o G6 LOT # )i 7
Facility Type: -SIFQ �4 xs!� New ❑ Expansion ❑ Repair
Basement? ❑ Yes '�K No Basement Fixtures? ❑ Yes 'K No
Type of Wastewater System ** Q.., °jb Q-C��UCX tti �J (Initial) Wastewater Flow: INSG GPD
(See note below, if applicable ❑)
°I a 9\G.ovcx lO-J �'5'VC n (Repair)
Installation Requirements /Conditions Number of trenches -r�-
Septic Tank Size Loo Q gallons Exact length of each trench ��b feet Trench Spacing: Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: 1 %. inches
Maximum Trench Depth of: SG-�• 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
Aggregate Depth:
Conditions:
inches below pipe
inches above pipe
inches total
* *If applicable: /understand the system type speciped is different from the type specired on the app lication. / accept the specifications of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorization is subject to revoca the site lat 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 su$gt�complianc�h t a t aws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: y-oV5 Date: 1 J1
Constru tk Authorization Expiration Date:
0
`LA V/
KKaN'� VCICY fl y j-,N1
Department of Environment, Health and Natural Resources
Division of Environmental Health
On -Site Wastewater Section
SOIL /SITE EVALUATION
for ON -SITE WASTEWATER SYSTEM
Owner: Applicant:
Address: Date Evaluated:
Proposed Facility: 1N, Design Flow (.1949): L)�Z �
Location of Site: Property Recorded:
Water Supply: ❑'Public❑ Individual ❑ Well
Evaluation MethodAuger Boring ❑ Pit ❑ Cut
Type of Wastewater: • ❑.- Sewage ❑ Industrial Process
Sheet:
Property ID:
Lot #:
File #:
Code:
Property Size:
❑ Spring
❑ Mixed
❑ Other
1
P
R
O
F
I
L
E
#
.1940
Landscape
Position/
Slope %
Horizon
Depth
(In.)
SOIL MORPHOLOGY
.1941
OTHER
PROFILE FACTORS
Profile
Class
& LTAR
.1941
Structure/
Texture
.1941
Consistence
Mineralogy
.1942
Soil
Wetness/
Color
1943
Soil
Depth (IN .)
.1956
Sapro
Class
.1944
Restr
Horiz
L?
0-377
G
1
-tv
so—
;P
5
0 -311
<�,
ft 'j- Rid
Description
Initial
System
Repair System
Other Factors (.1946):
Site Classification ( 1948):
Evaluated By: Tf
Others Present: v
Available Space (.1945)
v
°+
System Type(s)
Site LTAR