IPAC RRHTE# �` �o a ..ett County Department of Public dealth
Improvement Permit 27692
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: P \2A G 2-N
ISSUED TO: SUBDIVISION Cam . o/ 24N LOT #
NEW REPAIR EXPANON ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: `��' 0 ��� T y C) "/
Proposed Wastewater System Type: ZJ6 '1� �Z E�[1 U C'C 10 Q
Projected Daily Flow: �� GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes XNo
Pump Required: ❑Yes ❑ No �4 May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well i ®® feet
Permit conditions:
Permit valid for: Five years
❑ No expiration
Authorized State Agent:: Date: `t» I t ' ` o SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the iss of other permits. The permit holder i responsil le 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 Improve ent 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: a v-5H —SC"p, J �N�- PROPERTY LOCATION: pa-P, "(U57. L-si
SUBDIVISION �� TV'F -a-� a-,) S 1 LOT #
Facility Type: �P (tea "1�� �K New ❑ Expansion ❑ Repair
Basement? ❑ Yes `X No Basement Fixtures? ❑ Yes -10o
Type of Wastewater System ** 1° S, u S-TE-n (Initial) Wastewater Flow: GPD
(See note below, if applicable ❑) o
Installation Requirements /Conditions
Septic Tank Size t d ® d gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
P
Number of trenches 1
Exact length of each trench 3® ® feet
Trenches shall be installed on contour at a
Maximum Trench Depth of: N inches
(Trench bottoms shall be level to +/ -1/4"
in all directions)
GPM
Trench Spacing: cl Feet on Center
Soil Cover: --(1 inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
WATER LINES (INCLUDING IRRIGATION) MUST BE IOFT. FROM ANY PART OF SEPTIC SYSTEM OR REPAIR AREA.
NO UTILITIES ALLOWED IN INITIAL OR REPAIR DRAIN FIELD AREA.
inches below pipe
inches above pipe
inches total
*If applicable: /understand the system type specified is different from the type specifed on the app lication. / accept the specifications of this permit.
Owner /Legal Representative Sfgn Date:
This Construction Authorization is subject to revocation i to 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 is subje`c�compliance�islt, the prgsioCs aws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: Date:
Construct) Authorization Expiration Date:
—No
HTE# � _ PTO Permit #
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P -�a-� L 2--,1