IPACHTE# ~a-5-1;~LA 33 Harnett County Department of Public Health
Improvement Permit 2 6 5 5 $
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: ~Ti tr G cz ct~ t
ISSUED TO: t=-USUBDIVISION f--LOT # _
NEWX REPAIR ❑ EXPANSION Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: P%nr 110 tv-,r-
Proposed Wastewater System Type: Co Nv E Sri % ct N;>,I.-
Projected Daily Flow: 3~0 GPD
Number of bedrooms: Number of Occupants: - max
Basement ❑Yes ~ No
Pump Required: ❑Yes ?~1 No El May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tt~ feet Permit valid for A Five years
Permit conditions: ❑ No expiration
Authorized State Agent:: QEl15 Date: `F' a5I 1 1
SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuance i r permits. The permit holder is resp Bible 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 Improvements .t 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: 55:.,aqQ~ ] Luc, PROPERTY LOCATION:-71r, Cvca&'t4 `,p
r ~ SUBDIVISION 1_v c Rf2 LOT #
Facility Type: FNN)~ocn~ New ❑ Expansion ❑ Repair
Basement? ❑ Yes .8~ No Basement Fixtures? ❑ Yes
NO
Type of Wastewater System** C.4 N-tE-1,r1_ \Q NP,V (Initial) Wastewater Flow: GPD
(See note below, if applicable
(1c N-4 F_- .m )0r3 SaL (Repair)
Installation Requirements/Conditions Number of trenches t
Septic Tank Size N p Q 4 gallons Exact length of each trench 3 c~ 0 feet Trench Spacing: ~ Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: (6, inches
Maximum Trench Depth of. 1 73) 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 inches below pipe
n Aggregate Depth: a inches above pipe
Conditions:.5 es~, inches total
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.
**If applicable: l understand the system type specified is different from the type specified on the application. l accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
This Construction Authorization is subject to revoca io 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 Authorization is s ' c compliance v the is a La nd Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State Agent: 1horization Date: Constructio Expiration Date:
HTE#
ISSUED T0:
Authorized State Agent: V 26.5 "lv ~'Cdzx,SD Date: 12~~ }
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Department of Envilvnmenk Health and Nahual Resowr a Shed:
Division of FJMr0 meuW Health Property ID:
On-Site Wastewater Section pe
Lot e
SOMME EVALUATION File 0:
for OM-SITE WAgTlCWATE$ SYSTEM Code:
Owner. Applicant:
Address: Dam Evaluated:
Proposed Facility: -3 1399 t F10 0949): Fmpertf Size:
LocadotE o(Sits: Properly tree crdod: •
Water lion 4 PuW ❑ hxNdual ❑ Wen ❑ spring
Evaluation Mctliod: . .
Auger Boring ❑ Pit Cut ❑ Other
Type of Wastewater. Sewage ❑ Wastrial Process Mixet#.
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P SOM MORP1101AOY Ali
t 1940
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1941
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1941 Soil 113
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Site Classification (.1948)
9
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