IPACHTE# tarnt., County Department of Public ts,alth
Improvement Permit 2 6 5 7 9
ttCL eon Ck,~F-
I C hU" building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: M~L~N ~r~P~PGL C"UCLC -N-N i~
ISSUED TO: ~ Q-n4^C.:V0Q5 SUBDIVISION LOT #
NEWX REPAIR ❑ rE51` ANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: Ch v stc,-*.t " f`~'CG\~ + .I
Proposed Wastewater System Type: 9t1 ne \ 0 ~-s°fo Szug-: \o 4 eel
Projected Daily Flow: GPD
Number of bedrooms: Number of Occupants: max
Basement ❑Yes No
Pump Required4yes ❑ No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 1 OG feet
Permit conditions:
Permit valid for: Five years
❑ No expiration
Authorized State Agent:: t2C-~'~S Date: Q, 1 -7 1 11 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuance ther permits. The permit holler is esponsible 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 Improvemen 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
Reauired 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: PROPERTY LOCATION: c- r~, QA?-,0GL CHV2c~ ~Zp
SUBDIVISION LOT #
Facility Type: C't-) v(-tr-il ',a)i )LYSC le-A New ❑ Expansion ❑ Repair
Basement? ❑ Yes K No Basement Fixtures? ❑ Yes >~No
Type of Wastewater System** pv r,-) C 1 a r3-S06 ~-C911 Crt\ d 4 Gtr (Initial) Wastewater Flow: GPD
(See note below, if applicable
quv-e7rs (Repair) 1400"OF Q-ZR-0L_N E Q-ZQ a
Installation Requirements/Conditions Number of trenches SEC- Co,.01-V16,45
Septic Tank Size 3G 00 gallons
Pump Tank Size '3 S®o gallons
Pump Requirements: ft. TDH vs.
Conditions: flsta~t~st`~~t_n 1a ~E
Exact length of each trench feet
Trenches shall be installed on contour at a
Maximum Trench Depth of. 1S -SO inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
tAc--Z S C)", S,-rE-T0 DtSGUSS e"aCLC-~- <
Trench Spacing: Feet on Center
Soil Cover: G - lg inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
inches below pipe
Aggregate Depth: inches above pipe
S inches total
WATER LINES (INCLUDING IRRIGATION) MUST BE 1OFT. 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. / accept the specipcations of this permit.
Owner/Legal Representative Signature: Date:
This Construction Authoriza ect to revocation if thk s`te 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 stij ct,to complian d r'Oi of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit.
Authorized State Agent: \ zcin-5 Date: 61-71)
nstruction Authorization Expiration Date:
1c,
SEE ATTACHED SITE SKETCH
HTE# 1 "~OIC~S Permit # `lIG.-)
Authorized State Agent:
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