IPACHTE# /I ZS~ Harnett County Department of Public Health 2 4 5 5 3
Improvement Permit
A building permit cannot be issued with only an improvement Perm
o.n G. PROPERTY LOCATION: f ti° / 7 C `ii z I
ISSUED TO. lJ t`~ o,A ~ SUBDIVISION LOT #
NEW L~J REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: .~:E f') fti i:S-
Proposed Wastewater System Type: Co•~tr~ 1{ c .
Projected Daily Flow: J G GPD
Number of bedrooms: Number of Occupants: (z max
Basement ❑Yes ~ J'/-
Pump Required: ❑Yes __Lf No ❑ MgAe required based on final location and elevations of facilities
Type of Water Supply: ❑ Community E7 Public ❑ Well Distance from well feet Permit valid for.
Permit conditions: ~e years
O No expiration
L
Authorized State Agent: L' Date: .21114? 00 Ir SEE ATTACHED SITE SKETCH
Ttrc issuance of this permit the Health Department in no war guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies is 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, .1951,
installed in accordance with the .1954, .1955, 1956, .1957, .1958. and .1959 are incorporated by references into this permit and shall be met Systems shall be
attar system layout
ISSUED TO: m o_A d g 4r, tk I ,,,J PROPERTY LOCATION: 5'- / 7c 9
SF0 SUBDIVISION
Facility Type: 6S" EI/New ❑ Expansion
Basement? ❑ Yes 10 No Basement Fixtures? ❑ Yes ❑ No
Type of Wastewater System" C c AVc.%4-' (Initial)
(See note below, if applicable
❑ Repair
Wastewater Flow, 34 Q GPD
C o <<tre-~~' ~ ~ t ~ ` (Repair)
lestalhtion Itequaaaertts/Conditions
Septic Tank Size /000 gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Exact length of each trench -7 XJ 00 feet
Trenches shall be installed on contour at a
Maximum Trench Depth of. c2 y inches
(Tren(h bottoms shall be level to +/-I/4"
in all directions)
GPM
LOT # bi
Trench Spacing: g feet on Center
Soil (over. _L12- inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
11
fonditions: .5.~ arc..Aggregate Depth:
(n inches below pipe
a. inches above pipe
y,Z inches total
Iflicable: l understand the system type Jpecifred is different from the type specified on the application. l accept the specifications of this permit
Owner/Legal Representative Signature: Date:
This fonstruction Authorization is subject to revocation d the site plan, plat, or the intended use changes. The fonswction Authorization shall not be transferred when there is a change in ownership
of the site. Tha (onstroctan Authorization is subject to compliance with he provisions of the Laws and Rules (or Sewage treatment and Disposal and to the conditions of this permit.
C SEE ATTACHED SITE SKETCH
Authorized State Agent ~ C . ~ Date: ~ ca ~
Construction Authorization Expiration Date: ,2 cL,2
HTE # Of-Jr- l S -1 Tr Permit # y SS..3
Harnett County Department of 1'~ihlic Health
Site Sketch
PROPERTY LOCATON:-,5'.- / 70 9 /X 4 gn- C ksj, I
ISSUED TO: t « 4'.j C., A 4 ~ 1 ,d SUBDIVISION LOT #
AuthorM State Agent:, Date: cZ Y 20,-
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