IPACHTE#
ISSUED TO:
NEW ❑
REPAIR ❑
Type of Structure:
Proposed Wastewater System Type:
Projected Daily Flow:
Number of bedrooms:
Basement ❑Yes
❑ No
Pump Required: ❑Yes
❑ No
Type of Water Supply:
❑ Community
Permit conditions:
_ GPD
Number of Occupants: max
❑ May be required based on final location and elevations of facilities
❑ Public ❑ Well Distance from well feet
Permit valid for.
❑ Five years
❑ No expiration
Authorized State Agent:: Date: SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuance 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, 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: /4,A I a.J /or PROPERTY LOCATION: C:-i^, i- .
Facility Type: / li? New
Basement? ❑ Yes ❑ No Basement Fixtures? ❑ Yes
Type of Wastewater System**
(See note below, if applicable
Installation Requirements/Conditions
Septic Tank Size 000 gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Harnett County Department of Public Health
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION:
SUBDIVISION
(Repair)
Number of trenches C
Exact length of each trench
Trenches shall be installed on contour at a
Maximum Trench Depth of:
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
(Initial) Wastewater Flow: GPD
feet Trench Spacing: Feet on Center
Soil Cover: inches
inches (Maximum soil cover shall not exceed
36" above the trench bottom)
Ag regate Depth:
Conditions: t: ~5 k. Q'_,
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.
inches below pipe
inches above pipe
inches total
**If applicable: /understand the system type speciled is different from the type speciled on the application. / accept the specifications of this permit.
Owner/Legal Representative Signature: Date:
This Construction Authorization is subject to revocation 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 Authorization is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. SEE Al IACHED SITE SKETCH
Au
thorized State Agen . ,~4;4 rp Date:
IP~11
Construction Authorization Expiration Date: C l~ ct
26610
LOT #
EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
SUBDIVISION LOT #
❑ Expansion ❑ Repair
❑ No
HTE# //-~--=,2, L~- t-? Z Permit # Z b '~D 10
Harnett County ]Department of I-Niblic Health
Site Sketch
PROPERTY LOCATON:
ISSUED T0: 44A.-V SUBDIVISION LOT #
a~
Authorized State Agent c ZrItf Date: I/
C', r>/ At