IPAC RHTE# Harit,cit County Department of Public i Health 2 5 6 7 8
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: S ~cx~~Ip
ISSUED T0: SUBDIVISION
LOT #
NEW'X REPAIR ❑ EXPANSIOGt, ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: MPw4 Ni0t~ ~a,
Proposed Wastewater System Type: as 0.E000sc s dN
Projected Daily flow: GPD
Number of bedrooms: 3 Number of Occupants: max
Basement ❑Yes XNo
Pump Required: ❑Yes ❑ No May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well b O feet Permit valid for five years
Permit conditions: ❑ No expiration
Authorized State Agent:: Date: aS 101 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the 11;11-f 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, pla( or the intended use changes. The Improv nt Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of
the taws 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 T0: PROPERTY LOCATION: Ss oCX.ys D Sk
SUBDIVISION LOT #
Facility Type: \Ac) c r- (a`b '~~1d 1 I New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ Yes -X No
Type of Wastewater System** a S°!a R~ov Cf f d N (Initial) Wastewater Flow: d GPD
(See note below, if applicable
a,S°le Qrtp v~ % b'4 (Repair)
Installation Requirements/Conditions Number of trenches
Septic Tank Size o d gallons Exact length of each trench feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of. ~4'h - inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
Conditions: 14 -t- In @6c
GNazo~~, C3 . J lv , c w~
Trench Spacing: ) Feet on Center
Soil Cover: 1a.-Jb inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
l~ a U•s,L,-s c ~s M4~y
inches below pipe
inches above pipe
inches total
**If applicable: / anderrtand the system type specified is different from the type specified on the application. / accept the specifications of this permit
Owner/legal Representative Signature: Date:
This Construction Authorization is su ject cation 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 su
f~ectto compliat~wiatt- r ns of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: \~~~\~`\\2"5 Date:
ction Authorization Expiration Date: . 9
HTE# 01Permit # a 5~-1
narnett County Department of IN blic nealth
Site Sketch
PROPERTY LOCATON: S'socx~~~ ~p
ISSUED TO:~ P,soa ~C-~ N SUBDIVISION LOT #
Authorized State Agent: (AL"v b9- -KOI-*~.s OQ5 Date: X510
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