IPACHTE# ,3- 5.3,31 arnett County Department of Public Health
Imurovement Permit 27516
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: QOC-6 P-D
ISSUED TO: SUBDIVISION LOT #
NEW REPAIR L� ENSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: �6'xt-16
Proposed Wastewater System Type: Pta cnct .7o
Projected Daily Flow: Q Q C9 GPD
Number of bedrooms: a Number of Occupants: 1 Q max
Basement ❑Yes '�<No
Pump Required: Ves ❑ No ❑ May be required based on final location and elevations of facilities
Type of Water Supply ❑ Com unity Public ❑ We Distance from well 0' feet Permit v d for: Five years
Permit conditions: --tl_ e , -y Loi . 'Ns"t -�i J e � 1- 0'4j5 �rJ 0 ❑ No expiration
Authorized State Agent:: Date: 61 N 113 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuance of other ts. The permit holde is resp nsible 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, .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.�C ®M�� L•-C -~ PROPERTY LOCATION: o C,�5
SUBDIVISION '��rNQ Nif LOT # N�
Facility Type: STDk -t>Q xKL1 New ❑ Expansion ❑ Repair
Basement? ❑ Yes 'AS' No Basement Fixtures? ❑ Yes '`No
Type of Wastewater System ** QU Mew o =Q-- QV6 �� `� x'15 °= 6S" (Initial) Wastewater Flow: CO C) GPD
(See note below, if applicable ❑) i
PU tf•Q N d �..�[ a (;;-N CG JJ(Repair)
Installation Requirements /Conditions Number of trenches S-
Septic Tank Size t D- C) gallons
Pump Tank Size Q-S O gallons
Pump Requirements: ft. TDH vs.
Conditions: Q® �,) cs i Cites
Exact length of each trench 3 L4 Q feet
Trenches shall be installed on contour at a
Maximum Trench Depth of. Dog" —10 inches
(Trench bottoms shall be level to +/ -1/4"
in all directions)
GPM
1�'s a-y S l E.
Trench Spacing- I 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
t "1 4 inches total
WATER LINES (INCLUDING IRRIGATION) MAST BE LOFT. FROM ANY PART OF SEPTIC SYSTEM OR REPAIR AREA.
NO UTILITIES ALLOWED IN INITIAL OR REPAIR DRAIN FIELD AREA.
* *If applicable: / understand the system type specified is different from the type specified ofl the app /ication. / accept the specifications ofthis permit.
Owner /Legal Representative Signature: Date:
This Construction Aut b'ect 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 is s ect to complian rovision* a Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: Date:
Construct) thorization Expiration Date: _
HTE # \ I— 5— 3 X31 � Permit # x'151 G
ISSUED TO: Y" 1
Authorized State Agent:
H(arnett Comity I)eptartment of Public He(,dth
Site ietch
PROPERTY LOCATON: DOC6 140
E ----LC- SUBDIVISION Q P,-r-v-,0 11--i LOT #
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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: �� r
Proposed Facility: 5 Design Flow (.1949): JP�
Location of Site: Property Recorded:
Water Supply: ❑ Public❑ Individjaal. ❑ Well
Evaluation Method: ❑ Auger Boring Pit ❑ Cut
Type of Wastewater: ❑ Sewage Industrial Process
Sheet:
Property ID:
Lot #:
File #:
Code:
Property Size:
❑ Spring
❑ Mixed
❑ Other
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
f
'
o'
p
3C3� -j
SCI-
55)
e
Description'''►
Initial
S ste
Repair System
Other Factors (.1946):
Site Classification (.1948): S
Evaluated By:Q
Others Present: —
Available S pace (.1945)
System e(s)
P d NNP
Site LT I `
J