IPAC RRRHTE #—s= 761 Z -7 "< �
11 rnett County Department of Public Head
Improvement Permit 2 6 5 4 3
A building permit cannot be issued with only an Improvement Permit
_ PROPERTY LOCATION: I5 1
ISSUED TO- E"b(A& -Az /_"/��/Lg� !��l1 z? SUBDIVISION LOT #
NEW 7 REPAIR ❑ EXPANSION ❑ 7 Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: 5 Fb
Proposed Wastewater System Type: rfY1'PT I
Projected Daily Flow: GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes
Pump Required: ®Yes ❑ No L MMa}Ae required based on final location and elevations of facilities
Type of Water Supply: El Community Id Public ❑ Well Distance from well iOO feet
Permit conditions:
Permit valid for:
121 Five years
❑ No expiration
Authorized State Date: c� =-z - r j SEE ATTACHED SITE SKETCH
The issuance of this y e ealth Department in no way guarantees the issuance of other permits. The permit holder is responsible for chng 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, .1951, .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: % l wAyto+ % K -1 It4 PROPERTY LOCATION: tX_1`t_(oq
SUBDIVISION LOT #
Facility Type: New Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ Yes No
Type of Wastewater System ** 4or_J2Ze i-c Z3 t mss.,- (Initial) Wastewater Flow: 36D GPD
(See note below, if applicable ❑) i t
if Yw,,,�c %e sea' °3za (Repair)
Installation Requirements /Conditions Number of trenches Z
Septic Tank Size 1poQ gallons Exact length of each trench 120 feet Trench Spacing: Feet on Center
Pump Tank Size 1 00o gallons Trenches shall be installed on contour at a Soil Cover: inches
Maximum Trench Depth of: V 7 12 inches (Maximum soil cover shall not exceed
(Trench bottoms shall be level to +/ -1/4" 36" above the trench bottom)
in all directions)
Pump Requirements: ft. TDH vs. GPM inches below pipe
Aggregate Depth: inches above pipe
Conditions: -C° 'T_ 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 app lication. / accept the specifications of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorization is subject to revocation if the site plan, plat, or the intended use chances. The Construction Authorization shall not be transferred when there is a chance in ownershin of tho cite Thk
Construction Authorization is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State t: Date: i0 '� ��
Construction Authorization Expiration Date: — 1 f 447k I-Z— ll�
HTE# II—S"!- Z-7-70S-iye� Permit # 26 s
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