NCG551618_HD Septic System Permit_20201125

TOE RIVER HEALTH DISTRICT Permit Number 10919-3
IMPROVEMENT PERMITICONSTRUCTION AUTHORIZATION
i
/ Imurovement Permit
A building Hermit cannot be issued with only an Improvement Permit '
r- PROPERTY LOCATION: LA I' it O a\ I y( ) f_
ISSUED TO• dA5h� i-e re cL QS ts1_s.
New �( Repair ❑ Expansion ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure:
Proposed WastewaterS't� T e:�u � Projected Daily Flow: GPD
Number of bediCorns Number of Occupants: S
Basement ❑ Yes- frNo
Pump Required: 211"_es,O ,111 No ❑ May be required based upon final location and elevations of facilities
Type of Water Supply`:
I
Permit conditions: V C) P Wyy. IOC4 U) I�7 ✓lC,� Y`Cil1�%�
Authorized
Permit valid for: wive years
❑ No expiration
Date: I I- a'� 2a1±2� See Attached site sketch
t
The Issuance of this permit by the Health Department in noway guarantee he Issuance of other permits. The permlt 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
eouired for Building Permit
The construction and Installation requirements of Rules .1950, .1952, .1954, .1955, .1956, .1957, .1958,and.1959 are incorporated by reference Into this permit and
shall be met. Systems shall be Installed In accordance withthe attached system layout
(
ISSUED TO/'�1.r�1� TQ-t�.La
CR�. PROPERTY LOCATION: g
\ Gc� rnw
Facility Type: �r P 1 i � N New ❑ Expansion ❑ Repair
Basement? ❑ Yes C� No Basement Fixtures? ❑ Yes Ix No
Type of Wastewater System** %� 0 (Initial) Wastewater Flow: b' GPD
(See note below, if applicable ❑ ) r--� n of 1
� I `U 14_tt rl (Repair)
Installation Reotlirements/Conditions
Septic Tank Size; ( f gallons Total Trench Length: '( Z'5 feet Trench Spacing: -91 Feet on Center
Pump Tank Size: I'S.A.!!.1 gallons - Trenches shall be installed on co tour at a Soil Cover. inches
Maximum Trench Depth of: inches (Maximum cover shall not exceed
(Trench bottoms shall be level to +/- V" 36" above the trench bottom)
Pump Requirements: ft. TDH vs. _ GPM in all directions)
inches below pipe
Aggregate Depth: es above pipe
'.. I n 1 n. _ n..\ 11 ,, a_ .. w .. .. t _ . _ i L - I _inches EdTat
•'Ifaooilcabie:
I understand the system type specified is different from the type specified on the applicatton.
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 arjdlto the conditions of this permit
Authorized State Ag j l - a,� Attached site sketch
-� Date of Issuance:
PAGE OF�
Construction Authorization Expiration Date: �'s J

P92�y PERAM NUNIBER
r Toe River Health District
Site Sketch
❑ Improvement Permit Only! - No building permit to be issued lJmprovement Permit & Construction Authorization
eV(A<VYh1LZ ��-►' c�><� ZU IRei Gar, �
Applicant's Name Subdlvlslon/Section/Lot #
Ki
Auth6rized State Agent Date
System components represent approximate contours only! The contractor must flag the
system prior to beginning installation to insure proper grade is maintained!
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PIN V $34-00 -59 PERMIT NUMBER
Toe River lH'ealth District Operation Permit
& SPECIFIC SYSTEM INSTALLED: 1 f a-4�
System Type: Types V and VI systems expire in 5 years. (In Accordance With Table Va )
months prior to expiration for permit renewal.
f}loga, NC. ►cjrA l�r.
Owner's Name Property Address / S
`h_r
AutoriStttate Age System In ie
Owner must contact health department 6
`Z�2�2f1'l�l
Date
This system has been installed in compliance with applicable NC General Statutes, Rules for Sewage Treatment and Disposal, and all
conditions of the Improvement Permit and Construction Authorization. " _ t ,. i L. _ I , I._ —tie
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Pir f, , Kp r
PERMIT CONDITIONS:
I. Performance: System she}p with R I 1961 u s xi As required by u e
III. Maintenance: Ground absorption sewage treatment and disposal systems shall be checked, and the contents of the septic tank removed
periodically from all compartments, to ensure proper operation of the system. The contents shall be pumped whenever the solids level is found to be
more than 1/3 of the liquid depth in any compartment.
Other:
Subsurface system operator required? Yes _Nor
If yes. see attached sheet for additionaloperation conditions, maintenance and reporting.
Operation:
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