IPACHTE#M-G-ti°rc~,3 Harnett County Department of Public Health 2 4 5 2 5
Improvement Permit
A building permit cannot be issued with only an Improvement P,rmit
PROPERTY LOCATION:
SJG~-caN L M c_S-LA,t t- +~t~+PEL Cia "'C", 29
ISSUED TO: LN-CJZ ~LL.SOta SUBDIVISION LOT # 15
NEW REPAIR E~ EXPJ~ION ❑
Type of Structure: ! - - 6s'; Proposed Wastewater System Type: - G,-m s d rv P.l _
Projected Daily Flow: Li 'q O GPD
Number of bedrooms: 14 Number of Occupants: _..__max
Basement ❑Yes No
Site Improvements required prior to Construction Authorization Issuance:
Pump Required: ❑Yes A No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community ❑ Public "K Well Distance from well _ feet
Permit conditions:
Permit valid for.
Ive years
❑ No expiration
Date; f3 SEE ATTACHED
SITE SKETCH
Authorized State Agent: ~th=nt
The issuance of this permit by the Health Department in no war guarane of other permits. 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, plad 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, 1957, .1959. and .1959 are incorporated by references into this permit and shall be met. Systems shall be
installed in accordance with the ar ed system layout.
ISSUED TO: e_-4 s,, )-o 34 G PROPERTY LOCATION: Tha6aa G tq~4- C1tvrLr-vk
SUBDIVISION LOT #
Facility Type: 5F'D (42S"10 - New ❑ Expansion ❑ Repair
Basement? ❑ Yes . No Basement Fixtures? ❑ Yes 'ONO
Type of Wastewater System" C-0 -.r Ear; tin rr P ~ (Initial) Wastewater flow. 4"$0 GPD
(See note below, if applicable
O rv ~ E,.rf ~ 0 rv Rt-- (Repair)
InsWation l quinxttefrts/CWtdidons
3 ;~..ENc,1cs
Septic Tank Size 10C0 gallons
Pump Tank Size _ gallons
Pump Requirements: ft. TDH vs.
Exact length of each trench 10 feet
Trenches shall be installed on contour at a
Maximum Trench Depth of: 1x19 inches
(french bottoms shall be level to +1-114"
in all directions)
GPM
Trench Spacing: feet on Center
Soil Cover t g, inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
C inches below pipe
Aggregate Depth: a inches above pipe
Conditions: inches total
"*If applicable: ! understand the system type specified is different from the type specified on the application. l accept the specifications o/this permit
Owner/Legal Representative Signature: _ Date:
This Construction Authorization is subjecFro-r ocation if the site 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 ut rization is c ce with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit.
SEE ATTACHED SITE SKETCH
Authorized State Agent Date: ~3 6rZ
o uction Authorization Expiration Date: ti3
HTE# C`ab'
Permit # ~',ca s
Harnett (k)"'Ity Deli ll"lent of MMilk Health
Site Sketch
PROPERTY LOCATON: c~-C q, , C, , CN v ~
ISSUED TO: L c~ L, ~Lo,gc _ SUBDIVISION LOT # I
Authorized State Agent ~tLS Date: _ W) 13
5-83
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