IPACHTE# it°5-'s') 5-1 Harnett County Department of Public Health
Improvement Permit 2 6 3 9 9
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: Chtsz,s-~t~~ti "I-es~
ISSUED TO: 9e:T 5.0- Q Q'O n1 F~' SUBDIVISION LOT #
NEW*DI REPAIR ❑ EXPANSION ❑
Type of Structure: SIF0( (~,p
Proposed Wastewater System Type: ICs°' i-O f'
Projected Daily Flow: 219- 0 GPD
Number of bedrooms: a- Number of Occupants: max
Basement Xes ❑ No
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 )9~ Public ❑ Well Distance from well l00 feet
Permit conditions:
Permit valid for:
X Five years
❑ No expiration
Authorized State Agent:: : Rfz c~5 Date: '~~M \'l SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the iss a of other permits. The permit holder is r sponsible 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 t 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: PGs C--Q- C)0-r-0 .,a D PROPERTY LOCATION: C>, )P, r-4 Li61y,,
1 SUBDIVISION LOT #
Facility Type: 6FS]~?tQ06) New ❑ Expansion ❑ Repair
Basement? Yes El No Basement Fixtures? ❑Yes No
Type of Wastewater System** 6 O r° L--o (Initial) Wastewater Flow:
(See note below, if applicable
b 0 LjOy (Repair)
Installation Requirements/Conditions Number of trenches &
Septic Tank Size 1OC>C3 gallons Exact length of each trench Q J feet
Pump Tank Size gallons Trenches shall be installed on contour at a
NN e%a-
Maximum Trench Depth of: C.j° inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
Pump Requirements: ft. TDH vs. GPM
2)'Vo GPD
Trench Spacing: Feet on Center
Soil Cover: inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
Aggregate Depth:
Conditions: C bvi-..t,- *,+t~'S'-A :NM C'~vCSS 10,aS -P2')®f' "So 1t,5~FVri Pa)se,Vl
inches below pipe
inches above pipe
inches total
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.
**If applicable: / understand the system type specified is different from the type specified on the application. I accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
This fnmtrurtinn Authnrizatinn is suhiect to revocation if the site elan. plat or the intended use changes. The Construction Authorization shall not be transferred when there is a chance in ownership of the site. This
Construction Authorization is
Authorized State Agent:
compliance7a-- f the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE ATTACHED SITE SKETCH
Q --ris Date: a ':t 1l
h truction Authorization Expiration Date: 4
Authorized State Agent: \~~R~~S ~t~~G2 i o~,4SOO) Date: a1 ~t~ 1
6d
'1\ x 0
Department of Environment, Health and Natural Resources Sheet:
Division of Environmental Health Property ID:
On-Site Wastewater Section Lot Property
SOUJSITE EVALUATION File
for ON-SITE WASTEWATER SYSTEM Code:
Owner. Applicant:
Address: Date Evaluated dg~,}
Proposed Facility: 2 UOUa n Design Ftow (.1949: property Size:
Location otSiter. Praperty Recorded: g~
Wate>t Supply; .-Public ❑ individual ❑ Well ❑ Spring ❑ Other
Evaluation Method: uger Boring ❑ pit . Cut
Type of Wastewater. Sewage ❑ Industrial process Cj &IL~ced
P
R
O
P SOQMORPHOLOGY
OTHER
t 1940
.1941
PROFlU PACTORS
L Horizon
~
1941
E Poai
Depth .1941 .1941 9011 .1$43 .1956
11 stopa% (Ls) stuchow Considams Wetaap/
Ptotllti
.19
44
Ted Mlnralu Color 9011 3apro
Clap
Redr
Cram
Haris
A LTA>t
.
~f°C
6 y p LN ~~~~U
c
^ °SB 7t' 5 ;
. v fi1L55
Q S. ~
Q ~a .'S$z S VS-n SS~f
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Daaaipdao Initial Rapdir syatmm Other Facttxs (.1946k
s
Avallable s as .1945
Site CluMcation (.1948X 9-5
S atm4 ® t-a l.W Evaluated By:O-~
Sits LTAR Others Preme ~M M
>®tj a~ >a G