IPAC RRHTE# jS-5- _� ci aA Hari,ett County Department of Public dealth
27b91
Improvement Permit
A building permit cannot be issued with only aRRlmprovement Permit
PROPERTY LOCATION: F'fup'I(. >G 1_'J
ISSUED T0: c� u T}-1 ° SC p J �rs G SUBDIVISION inn c, rfG 1,s �1 �f �F c.�'rn< Q v N LOT # 9
NEW X REPAIR ❑ E) NSION El Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: 5VU .
Proposed Wastewater System Tyyppe:��b
Projected Daily Flow: 'O GPD
Number of bedrooms: Number of Occupants: max
Basement [--]Yes No
Pump Required: ❑Yes ❑ No ' Pay be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community' Public ❑ Well Distance from well l® V' feet Permit valid for: Five years
Permit conditions: \.. c ❑ No expiration
Authorized State Agent:: ����. ? S Date: � _ )3 11 tf� r) SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issu other permits. The permit holder 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 Improw—eniOP4 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: S ®J �j _S l'`' C > PROPERTY LOCATION:
SUBDIVISION "i LOT # 1A
Facility Type: ���% `�6 x�'' New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixt res? ❑ Yes ';R,'No
Type of Wastewater System ** -_,I.5 °/0 y C;v d N S ? 5S 0.tN (Initial) Wastewater Flow: GPD
(See note below, if applicable ❑)
Y v Mp'"'SG 1e (Repair)
Installation Requirements /Conditions Number of trenches 1
Septic Tank Size �- ® Q)Q gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
Exact length of each trench -:S ®0 feet
Trenches shall be installed on contour at a
Maximum Trench Depth of: \1 inches
(Trench bottoms shall be level to +/ -1/4"
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
WATER LINES (INCLUDING IRRIGATION) MUST 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 on the application. / accept the specifications of this permit.
Owner /Legal Representative Signatu Date:
This Construction Authorization is subject to rev cation if I t n, 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 �e2ticompliance w thevis! Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: l Date: f j /-3
onst ion Authorization Expiration Date:
HTE# Permit #
cir,
,,� -NJ N3
LOS
MmfL\E Lo