IPAC - noticed that this was deleted by someone accidently -rescanned todayHTE# o$ - 5 -)9"tQ i r ELi County Department i i.,alth 24530
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION:
ISSUED T0: �� ���- �� �� SUBDIVISION IF cc -% e,.tt�oj(L LOT #
NEW REPAIR ❑ JANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: SFS] L�Orx°i O
Proposed Wastewater System Type: C.o i N A t_
Projected Daily Flow: 36O GPD
Number of bedrooms: `�> Number of Occupants: max
Basement ❑Yes X No
Pump Required: ❑Yes ', No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Well Distance from well 1M feet Permit valid for Five years
Permit conditions: ❑ No expiration
Authorized State Agent:: RS Date: �� aa) ®� SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way gua the issuance of other permits. The permit h Ider is responsible for checking with appropriate governing bodies in meeting
their requirements. This site is subject to revocation if the site plan, plat, or a 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: �'� t �z t-, NNs-�o PROPERTY LOCATION:
SUBDIVISION V- lK Av\ \ P\-) Loa- LOT #'C
Facility Type: 5�9 7O� "� Z�� New ❑ Expansion ❑ Repair
Basement? ❑ Yes >S, No Basement Fixtures? ❑ Yes �A'No
Type of Wastewater System" D., L- (Initial) Wastewater Flow: 0 GPD
(See note below, if applicable ❑)
C-1 rv��..�„-<�p tv rhr^ (Repair)
Installation Regoi ents/Conditions
ci- —\2GrvC)"\GS
Septic Tank Size 1-�nctiC—) gallons Exact length of each trench '15 feet Trench Spacing: Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: ` \__19 inches
Maximum Trench Depth of. atA -31� 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: a inches above pipe
Conditions: , inches total
"If applicable: / understand the system type specified is different from the type specified on the application. / accept the specilcations 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 transterred when there is a change in ownership
of the site. This Constructio uthorization is omp' ce 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: -11 D'd 69
ruction Authorization Expiration Date:
HTE#
Permit # a45'30
Harnett ( ";0unty Depailinent of 'liblic Health
Site Sketch
PROPERTY LOCATON:
ISSUED T0: �RP.N � Nr SUBDIVISION V4,N,ce:,, "'• LOT #`T�`�
Authorized State Agent 6LS (PL1,4G.JZ
NVLYso�,V Date: a1 �',
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