IPACHTE #-N S Harnett County Department of Public Health 28304
Improvement Permit
A building permit cannot be issued with only atS,�nprovement Per it
I PROPERTY LOCATION: jj'' �� A � S
ISSUED T0: T� cs 6� i�'� N S SUBDIVISION a LOT # 5_
NEW REPAIR ❑ XPANSION-5 Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: m n' 16^'c C I
Proposed Wastewater System Ty pe: P v rnP i 'i '�v�N 0"J
Projected Daily Flow: 360 GPD
Number of bedrooms: `3 Number of Occupants: max
Basement [--]Yes .< No
Pump Required>!lYes ❑ No
Type of Water Supply: ❑ Community
Permit conditions:
❑ May be required based on final location and elevations of facilities
Public ❑ Well Distance from well 04 feet Permit valid for: the years
�c ❑ o expiration
Authorized State Agent:: �'�� �uS Date: 3 I °3 � �� SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the iss. 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 Improv 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: Vpvz-A `G7- �`Q zvQ� P� F�,G� PROPERTY LOCATION: �S
SUBDIVISION Qt>-( PQ- C5-Sc5"ES LOT #
Facility Type: ��� x� �,1��� New ❑ Expansion ❑ Repair
Basement? ❑ Yes A No Basement Fixtures?/ EJ Yes �No
Type of Wastewater System** PU'(n(p ! o I-C'-T� Q)Q (Initial) Wastewater Flow: 3�-O GPD
(See note below, if applicable ❑)
p u '(�e 1:)-S70100 (Repair)
Installation Requirements/Conditions Number of trenches 3
Septic Tank Size ti0 ® '�D gallons Exact length of each trench LJ C) feet
Pump Tank Size Lo gallons Trenches shall be installed on contour at a
Maximum Trench Depth of. lR-30 inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
Conditions:
Trench Spacing: feet on Center
Soil Cover: inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
WATER LINES (INCLUDING IRRIGATION) MUST BE ]OFT. 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 system type specified is different from the type speciped on the application. / accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
This Construction Authanza' � c�revocafi�oniltthe ite 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 suto e proevisi the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent: Date: li.3,1 aS
on Authorization Expiration Date: 'aQ
HTE # IS - 5`3�53) 2 -
ISSUED TO:
Authorized State Agent:
MR.
Permit #
Department of Public Health
Site Sketch
PROPERTY LOCATON: MP q,�--S qZ
SUBDIVISION iSxU)1,2 � "� ES LOT #
Do L,3)� Date: 31
M
0A)e— 5—.
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): rad
Location of Site: Property Recorded:
Water Supply:ublic❑ Individual ❑ Well
Evaluation Method Aug?Borng ❑ Pit ❑ Cut
Type of Wastewater: N Sewage ❑ Industrial Process
Sheet:
Property ID:
Lot #:
File #:
Code:
Property Size:
❑ Spring ❑ Other
❑ Mixed
FR
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
1943.1956
Soil
Depth (1N.)
Sapro
Class
.1944
Restr
Horiz
1
LS
iI
IN
I; }
Description Initial Repair System Other Factors (.1946):
SysteI4 Site Classification (.1948):.5
Available Space (.1945) V V Evaluated By: �+
System Type(s) r~ VM J, 1 Others Present:
Site LTAR _ y