IPAC RHTE# td- 5'a9 -.90V., oarnett County Department of PuDlic Health
1
Ia�„�j �,�— A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: ► owE.2. 9A
ISSUED TO: � SUBDIVISION PPrs"4C) rtS o t�,C) LOT # Ia4V
NEWX REPAIR ❑ PANSION I—] , Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: 'SFU t 4 -A C 4' LI x3t
Proposed Wastewater System Type: IV!i1"o V-4---OuCrN l OW
Projected Daily Flow: 3roQ GPD
Number of bedrooms:_ Number of Occupants: Co max
Basement 171 Yes No
Pump Required: ❑Yes XNo ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet Permit valid for: Five years
Permit conditions: ,—w ❑ No expiration
Authorized State Agent:: >- — 115 Date: 1 � �'�—��11�� SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantee t ' s ice of other permits. The permit hold r is respAsible for checking with appropriate governing bodies in meeting their requirements. This
site is subject to revocation if the site plan, plat, or the intende use changes. The It ement 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 a con 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� PROPERTY LOCATION: MNcSUSawG2 Q,b
SUBDIVISION Pali o ray V a t '.ri LOT # I a
Facility Type: 5�-�� ,i3x3a� New ❑ Expansion ❑ Repair
Basement? ❑ Yes X No Basement Fixtures? ❑ Yes ,X No
Type of Wastewater System ** c` 5 ®�� �Epv 0,1� s V W S yS T GM (Initial) Wastewater Flow: 360 GPD
(See note below, if applicable ❑)
a,5�b Eq~Jcli VI SY'5t t-�rn (Repair)
Installation Requirements /Conditions Number of trenches a
Septic Tank Size t o Od gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
Exact length of each trench -15 feet
Trenches shall be installed on contour at a
Maximum Trench Depth of. V�Z inches
(Trench bottoms shall be,.level to +/ -1/4"
in all directions)
GPM
Trench Spacing: Feet on Center
Soil (over: inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
inches below pipe
inches above pipe
inches total
**If applicable: / understand the system type specified is different from the type specified on the app lication. / accept the specifications of this permit
Owner /Legal Representative Signature: Date:
This Construction Authorization is subject ation 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 su 'ect� compliances t — _ visions a Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: 2C%5 Date: ! )akA
Authorization Expiration Date:
HTE # Q-, — Permit # � 5 550
H.-U- nett County Department of -Mtblic Health
Site Sketch
elo-AaQ Lk;-) Ii) Q) 1.
ISSUED TO:
Authorized State Agent:
U-4 "S SD
'llwl�
PROPERTY LO(ATON: M )ca TT . vlr,- Z 9..Ib
SUBDIVISION IPCIM RID rr LOT #
Date: v 2'A)I)3
�S�fc�5 2•� 13, i
)3
C, �