IP onlyHTE# I3- 5- 3��°1� Harnett County Department of Public Health 27923
Authorized State Agent:: Date: 4 J 1 Sl SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department iir-no way guarantees the i ue o they permits. The permit holder is resp risible 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 Improvermit 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:
Facility Type:
Basement? ❑ Yes ❑ No
Type of Wastewater System **
(See note below, if applicable ❑)
❑ New
Basement Fixtures? ❑ Yes
Installation Requirements /Conditions
Septic Tank Size gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
PROPERTY LOCATION:
SUBDIVISION
❑ Expansion ❑
❑ No
(Repair)
Number of trenches
Exact length of each trench
Trenches shall be installed on contour at a
Maximum Trench Depth of:
(Trench bottoms shall be level to +/ -1/4"
in all directions)
GPM
Repair
LOT #
(Initial) Wastewater Flow: GIRD
feet Trench Spacing: Feet on Center
Soil Cover: inches
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 Signature: Date:
This Construction Authorization is subject to revocation 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 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 Agent: Date: —
Construction Authorization Expiration Date:
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: C ok6� U�-y P'-C)
TO: Noct �N va�'�
\ ,
CAA SUBDIVISION LOT #
NEW;< REPAIR ❑
EXPANSION ❑ ,, Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: F-1 K:)
E4 p+2:c�iC cS �Zlbb�
Proposed Wastewater System Type:
ocvvEsvS S o NP,1
Projected Daily Flow: `.�-S GPD
Number of bedrooms: —
Number of Occupants: max
Basement ❑Yes XNo
Pump Required: ❑Yes ❑ No
be required based on final location and elevations of facilities
�Mray
Type of Water Suppl : El Community ✓� Public ❑ Well Distance from well feet jermit valid for: Five years
�PgEfl L G�eet_.G
Permit conditions: EX�r,�
Ica +�*afl �st: 0,s P,NS� C' pbS L^ ❑\6 expiration
S ., P, , ) *-�-F-Q
r--'\Z ` P . G o OAT N try r.Lo' n,. '�°t�, t S T b.T F
Authorized State Agent:: Date: 4 J 1 Sl SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department iir-no way guarantees the i ue o they permits. The permit holder is resp risible 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 Improvermit 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:
Facility Type:
Basement? ❑ Yes ❑ No
Type of Wastewater System **
(See note below, if applicable ❑)
❑ New
Basement Fixtures? ❑ Yes
Installation Requirements /Conditions
Septic Tank Size gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
PROPERTY LOCATION:
SUBDIVISION
❑ Expansion ❑
❑ No
(Repair)
Number of trenches
Exact length of each trench
Trenches shall be installed on contour at a
Maximum Trench Depth of:
(Trench bottoms shall be level to +/ -1/4"
in all directions)
GPM
Repair
LOT #
(Initial) Wastewater Flow: GIRD
feet Trench Spacing: Feet on Center
Soil Cover: inches
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 Signature: Date:
This Construction Authorization is subject to revocation 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 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 Agent: Date: —
Construction Authorization Expiration Date: