IPACHTEHarnett County Department of Public Health 28308
Improvement Permit
A building permit cannot be issued with only an Improvement Perm''
\ PROPERTY LOCATION: 9n)a } , L N
ISSUED TO: V—)�'� CSS'," 1 N C- SUBDIVISION b Ly LOT #
NEWS' REPAIR E], �' 3 E NSION I—]SiteImprovements required prior to Construction Authorization Issuance:
Type of Structure: 1,
Proposed Wastewater System Type: � a
Projected Daily Flow: b GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes :E'No
Pump Required: ❑Yes ❑ No May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community �, Public ❑ Well Distance from well l ®G feet
Permit conditions:
Permit valid for: ',Five years
❑ No expiration
Authorized State Agent:: Date: 3 1 Z3 S SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issua ther permits. The permit holder is reiponsible 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 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: a tai)-) PROPERTY LOCATION: �� ��2� � LN
SUBDIVISION �o�"i Cr2Sy LOT #
Facility Type: S Q"P �"�3$ New ❑ Expansion ❑ Repair
Basement? ❑ Yes L No Basern nt Fj ttur�es? ❑ Yes �No
Type of Wastewater System**�1 `��; 1 �s� �7s �Gsr (Initial) Wastewater Flow: GPD
GPD
(See note below, if applicable ❑h
��` V m P a 16, (Repair)
Installation Requirements/Conditions Number of trenches
Septic Tank Size 1 exp gallons Exact length of each trench feet Trench Spacing: Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: C- � inches
Maximum Trench Depth of: 1�% "3® 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
Aggregate Depth:
Conditions:
WATER LINES (INCLUDING IRRIGATION) MUST BE 10FT. 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 specified is different from the type speciped on the application. / accept the specilcations of this permit
Owner/Legal Representative Signature: Date:
This Construction Authorization is subject to rev7,ith'fth'_ep�rohe
he 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 islkbje�t�comp a Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Authorized State Agent:
Date: 31b-5-
11
s
I Constri&t�n Authorization Expiration Date: 11
HTE# �5 -5 5-7 Permit # 3C��
CountyHarnett • 1, of PablicHealth
Site Sketch
PROPERTY LOCATON: �)a, )q,>E---�
)
ISSUED TO: o u s SUBDIVISION � QA -77 C.' r—UFF LOT #
Authorized State Agent: �OLly�,25 0}SDU�y Date:
*MA eA& 1-I►
Department of Environment, Health and Natural Resources
Division of Environmental Health
On -Site Wastewater Section
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
Sheet:
Property ID:
Lot #:
File #:
Code:
Owner: Applicant:
Address: Date Evaluated:
Proposed Facility: I-) Design Flow (.1949): Ll�� �� Property Size:
Location of Site: Property Recorded:
Water Supply:'ublic❑ Individual E] Well El Spring
Evaluation Method:❑ Auger Bori�li g Pit F-1cut
Type of Wastewater: wage ❑ ndustrial Process ❑ Mixed
❑ Other
P
R
O
F SOIL MORPHOLOGY
I .1940 .1941
L Landscape Horizon
E Position/ Depth .1941 .1941
# Slope % (In.) Structure/ Consistence
Texture Mineralogy
OTHER
PROFILE FACTORS
Profile
Class
& LTAR
.1942
Soil
Wetness/
Color
1943
Soil
Depth (IN.)
.1956
Sapro
Class
.1944
Restr
Horiz
�S
Description Initial Repair System Other Factors (.1946):
Syste Site Classification (.1948):
Available Space 1.1945) Evaluated By:
System Type(s) 2S J rGLvfvg Others Present:
Site LTAR