IPAC RHTE# ari,,Lt County Department of Public` „.-oalth
Improvement Permit 27,684
A building permit cannot be issued with only app �Improvement Permit
� PROPERTY L
® OCATION: Koss a i �t�s�,s,s
ISSUED TO: �� -C=��i V C�.'CP�C�Q Y P1 1Z- Q03 SUBDIVISION GtZo Cc- PQ--, NC.E LOT #
NEW° REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: rn 1 jOr°nC.
Proposed Wastewater System Type: %"I L
Projected Daily Flow: -"!> (4::>10 GPD
Number of bedrooms: _5 Number of Occupants: IG max
Basement ❑Yes No
Pump Required: ❑Yes ;f No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ! O O feet Permit valid for: Five years
Permit conditions: ❑ No expiration
Authorized State Agent:: ' Date: t ®1'11 l3 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the is c f other permits. The permit holder is respo Bible for checking with appropriate governing bodies in meeting their requirements. This
site is subject to revocation if the site at, or itended use changes. The Improv'efhent 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 lo Se age r nd o itions of this permit..
WS
Required for Building Permit
The construction and installation requirements of Rules .1950, .1952, .1959, .1955, .1956, .195
with the attached system layout.
ISSUED TO: T-2 -{ 04 QS�(NO C, � P,Llx --6 c�
Facility Type: cyS (&A"Asc New
Basement? ❑ Yes No Basement Fixtures? ❑ Yes
Type of Wastewater System **
(See note below, if applicable ❑)
1, .1958. and .1959 are incorporated by references into this permit and shall be met. Systems shall be installed in accordance
PROPERTY LOCATION: b
SUBDIVISION LOT #
❑ Expansion ❑ Repair
No �
(Initial) Wastewater Flow: GPD
® 1�. &0 vC--C a (Repair)
Installation Requirements /Conditions Number of trenches
Septic Tank Size I (n ®c7) gallons Exact length of each trench �3S feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of: inches
(Trench bottoms shall be level to +/ -1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
Conditions:
Trench Spacing: ) Feet on Center
Soil Cover: C'°D, inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
WATER LINES (INCLUDING IRRIGATIONS MUST BE LOFT. 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 specified on the app /ication. / accept the specifications of this permit.
Owner /Legal Representative Signat • Date:
This Construction Authorization is subject to r ocation if i to lat, 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 su compliance th aws and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State A t: Date: 10�
�3 Cons ion Authorization Expiration Date:
HTE# Permit
L�5 P
I
D
eye
v
C-
7
3
�F µi