IPAC Rar,z tt County Department of Public Aealth
Improvement Permit 27300
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: \iJ1SZE
ISSUED TO: GF�v V -I )rA0 I--LC-, SUBDIVISION Vr--N Lfs 4 LOT #
NEW.K REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure:
Proposed Wastewater System Type: Po mas dX1
Projected Daily Flow: q-t GPD
Number of bedrooms: L4 Number of Occupants: Amax
Basement ❑Yes KNo
Pump Required:' ,Yes ❑ No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well t (Dd feet Permit valid for: Five years
Permit con ' ' ❑ No expiration
Authorized State Agent:: Date: 5) 3 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Healt ment in no way guarantees t ' su other permits. The permit hold r is re ponsible for checking with appropriate governing bodies in meeting their requirements. This
site is subject to revocation if th it planplan, pl e use changes. The Improven E 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 Treatm Disposal of this permit..
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 TO: �'�Nvy`/ �AoTCNC--5 Ll.-C- PROPERTY LOCATION: VIQ4
SUBDIVISION �..t L-%g �2t� LOT #
Facility Type: J�� ��a �� New ❑ Expansion ❑ Repair
Basement? ❑ Yes X No Basement Fixtures? ❑ Yes X No
Type of Wastewater System ** v � —� ® S��Q' !Re yM10 s'J
(See note below, if applicable ❑)
P U �e�d 2 �0 'kCD\J E s t 131 (Repair)
Installation Requirements /Conditions Number of trenches
Septic Tank Size t b g ® gallons Exact length of each trench `7 ® feet
Pump Tank Size t d gallons Trenches shall be installed on contour at a
Maximum Trench Depth of: tt -QL4 inches
(Trench bottoms shall be level to +/ -1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
_ (Initial) Wastewater Flow: L*Wd GPD
Trench Spacing: `'i Feet on Center
Soil Cover: G _ )2- inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
Conditions: 5 y PQ1-� 1--1 ,s G d ,sGmE s s� �Lp,� s \'JS � �j„ED
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.
inches below pipe
inches above pipe
inches total
* *If applicable: l understand the ryrtem type rpeciped if different from the type speciped on the application. l accept the specipcationr of this permit.
Owner /Legal Representative Signature: Date:
This Construction Authorization is subject ation if the it e 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
ction Authorization ' o compli with the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Auth ' d Sta a 5 Date: 3 '3
r,,, s
161,,1 Con n Authorization Expiration Date:
HTE# �3._ 5" �-7 10 � Permit # 2Z�3 ®o
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