IPACHTE# rS -S Harnett County Department of Public Health 28177
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
�—� -- PROPERTY LOCATION: 1 i
ISSUED TO: ia) 0-q1N SUBDIVISION LOT #
NEW REPAIR PANSION E3Type of Structure: _
Proposed Wastewater System Type: 2—Sb�e RZ-y
Projected Daily Flow: 3GPD
Number of bedrooms: 3 Number of Occupants: max
Basement ❑Yes ;1�90
Site Improvements required prior to Construction Authorization Issuance:
Pump Required: ❑Yes --:1 No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community ,1K, Public ❑ Well Distance from well 10 0 feet Permit valid for: Five years
Permit conditions: �I ❑ No expiration
Authorized State Agent:: Date: _�)�J l5 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuanceo ermits. 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, plat or the intended use changes. The Improvement Per 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, .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:H dPROPERTY LOCATION:
( SUBDIVISION ®' LOT #
Facility Type: New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basemen Fixtures? ElYes 'X No
Type of Wastewater System** 2,�0 1j2Gn'icz"Slo NJ S�/���fyN (Initial) Wastewater Flow: ?4D GPD
(See note below, if applicable ❑) �S o `G
L nCavCsct o (Repair)
Installation Requirements/Conditions Number of trenches
Septic Tank Size t Q ® C) gallons Exact length of each trench i5 feet
Pump Tank Size gallons Trenches shall be installed on contour at a
Maximum Trench Depth of: 1� -" inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
Conditions:
Trench Spacing: 9 Feet on Center
Soil Cover: — ) q inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
WATER LINES (INCLUDING IRRIGATION) MUST BE IOFT. 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: /understand the system type speciled 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 t&-revcation if the site plan, plat, or the intended use changes. The Construction Authorization shall not he transferred when there is a chance in ownership of the site. This
Construction Authorization is suhj�ct compliance wt�y� tel Pratt Fa\3fa �f the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this
Authorized State Agent: 2;-- )-4 S Date: 'i l
Cons tion Authorization Expiration Date: ��
SEE ATTACHED SITE SKETCH
NTE# �S " E)-352-�
Permit # M 1 I -�
Department ®f niblic Health
Site Sketch
PROPERTY LOCATON:
ISSUED T0:'� ��� 1 n aS SUBDIVISION
Authorized State Agent: ((Jc,)Vc�L 7,OLX5Dd(�
v SC
1-1 l (11<-5 P -Q
Date:
LOT #
Department of Environment, Health and Natural Resources
Division of Environmental Health
On -Site Wastewater Section
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
Owner: Applicant:
Address: Date Evaluated:
Proposed Facility: Design Flow (.1949): O t
Location of Site: Property Recorded:
Water Supply: [`Public❑ Indi 'dual ❑ Well
Evaluation Method Auger Boring tt ❑ Cut
Type of Wastewater: 'f -I Sewage ❑ dustrial Process
Sheet:
Property ID:
Lot #:
File #:
Code:
Property Size:
❑ Spring
❑ Mixed
❑ Other
P
R
O
F
I
L
E
#
.1940
Landscape
Position/
Slope %
Horizon
Depth
(In.)
SOIL MORPHOLOGY
.1941
OTHER
PROFILE FACTORS
Profile
Class
& LTAR
.1941
Structure/
Texture
.1941
Consistence
Mineralogy
.1942
Soil
Wetness/
Color
.1943
Soil
Depth (IN.)
.1956
Sapro
Class
.1944
Restr
Horiz
,5
C,!v
Jac =.a its
Ic 11
5
:7
Description Initial Repair System Other Factors (.1946):
S ste Site Classification (.1948): A 5
Available Space (.1945) Evaluated By: (j�1
System Type(s) Cl G Others Present:
Site LTAR