IPAC RHTE# Harnett County Department of Public Health 2 4 6 6 4
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
ISSUED TO: cl C.. Rt- PROPERTY LOCATION: cfi y (
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NEW )L REPAIR ❑ EXPANSION ❑ SUBDIVISION LOT #
Type of Structure: Q R Site Improvements required prior to Construction Authorization Issuance:
Proposed Wastewater System Type: uA Y -t- 2 i c( f~ 1
Projected Daily Flow: D GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes'ffo
Pump Required: ❑Yes ❑ No 'id-May be required based on final location and elevations of facilities
Type of Water Suppl . ❑ Community ~ Public ❑ Well Distance from well 51) - feet
Permit valid fort Five
Permit conditions. U 17 c Z 12 T '11, ~ years
0 r- 0~ I, U (3 `N ter, 7-' t \ \ c El No expiration
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Authorized State Agent: Date: SEE ATTACHED SfTE SAET[H
The issuance of this permit by t 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 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, AM. .195S, .1956, AM, .1958, and .1951 are incorporated by references into this permit and shall be met. Systems shall be
installed in accordance with t e attached system layout.
ISSUED TO: CIA, I.( tar VA~11 - ~r ~6n 6AJ PROPERTY LOCATION: Y
SUBDIVISION i-. ale r LOT
Facility Type: S n- G31 S'J- 3 Girt New ❑ Expansion El Repair
Basement? ❑ Yes Non Basement fixtures? ❑ Yes ~6"o
Type of Wastewater Sys of m** V1 rA r -f 2 i 'k /-r/ It,1 (Initial) Wastewater Flow. 3~, J GIRD
(See note below, if applicable 0
4~ (Repair)
In9 faon Ilegnirerttettts/Conditiatu
Septic Tank Size ODD gallons
Pump Tank Size 00 gallons
Pump Requirements: ft. TDH vs.
Conditions:
Exact length of each trench feet
Trenches shall be installed on (ntour at a
Maximum Trench Depth of, inches
(Trench bottoms shall be level to +1-114"
in all directions)
GPM
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 a li I / undeatand the srrtem type .specified it different from the type .rpeci;red on the app/ication. / accept the roecificationr of thif 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 bject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit.
Authorized State Agent: v~ SEE ATTKNED SITE SMG
Date: 1 1 a_
Construction Authorization Expiration Date:2, -
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HTE# 09.00- 17y~ y/~ Permit # _42 ~ (0
Harnett County I epartillent of 1),I)lic Health
Site Sketch
''11 PROPERTY IOCATON: b c{
ISSUED T0: C1,4N SUBDIVISION
LOT #
Authorized State Agent c
ti Date:
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