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IMPROVEMENT PERMIT
Beaufort County Health Department
Environmental Health Section
220 North Market St.
Washington NC 27889
Phone: [phone] Fax: 252 - 946 -2074
For Office Use Only Page 1 of 2
*CDP Fife Number 123283-1
County ID Number: 7610656332
Evaluated For: REPAIR
PERMIT VALID UNTIL: 0 9/18 / a 0 18
*NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with only an Improvement Permit. ❑
FIII Sheet CA?
Applicant: Mohamed Ali Darar
Property Owner:
Mary McDonald
Maximum Trench Depth:
Address: 1205 Kindale Drive
Address:
5616 State Hwy DD
Fill Depth:
City: Raleigh
City:
Fetus
State/Zip: NC
27615 State/Zip:
MD
63026
Phone #:
11P #:
Address 734 Old Pamlico Beach Rd
Property Location & Site Information
Road #Belhaven NC 27810
Subdivision:
Phase:
Lot:
Township:
Directions
Structure: SINGLE FAMILY
Pamlico Beach Road East
# of Bedrooms: 3
# of People: 6
11`W Supply: PUBLIC
Initial System
System Specifications
*Site Classification: NIA
Saprolite System? 0 Yes (9 No
Minimum Trench Depth:
a
4 inches
Design Flow: 3 6
Maximum Trench Depth:
a
4 Inches
Soil Group:
Fill Depth:
Inches
Soil Application Rate:
Septic Tank:
1 0
0 0 Gallons
*System Classification /Description:
TYPE II A. CONY SYSTEM (SINGLE- FAMILY
OR 480 GPD OR Pump Required:
0 Yes
(g No 0 May Be Required
Pump Tank:
Gallons
*Proposed System: CONVENTIONAL
Repair System Required: 0Yes No
0 No, but has Available Space
Repair System
*Site Classification:
Minimum Trench Depth:
Soil Application Rate:
Maximum Trench Depth:
*System Classification /Description:
Fill Depth:
Pump Required:
*Proposed System:
Pump Tank:
Inches
Inches
Inches
C) Yes 0 No 0 May be Required
Gallons
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department.
*Site Modifications
The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. T
is responsible for checking with appropriate governing bodies in meeting their requirements.
*Permit Conditions Pump and crush existing tank; backfill with sand; set new 1000gal tank and distribution box; install
all piping and 3 lines (3'x 40') conventional rock trenches for repair; use soil cloth; maintain setbacks
The Department and Local Health Department may impose conditions on the issuance and may revoke the permits for failure of the system to
satisfy the conditions, the rules, or this article. This permit is subject to revocation if the site plan, plat, or intended use changes (NCGS 13OA -335
The person owning or controlling the system shall be spon ible for assuring compliance with the laws, rules, and permit conditions
regarding system location, installation, operation, mainte c on' rin eporting, and repair (.1938(b)).
*Authorized State Agent: 2018 Hager, Matthew % Date of Issue: 0 g / 1 $ / 0 1 3
0Hand Drawing 0 imp Draw * *Site PlanlDrawing attached. ** Total Time:(HH:MM)
Activity Code: 0 Hours Minutes

0ie
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1712
CONSTRICTION AUTHORIZATION
Beaufort County Health Department
Environmental Health Section
220 North Market St.
Washington INC 27889
Phone: [phone] Fax: [phone]
Applicant:
Mohamed All Darar
Address:
1205 Kindale Drive
City:
Raleigh
State /Zip:
NC 27615
Phone #:
# of People:
Address734 Old Pamlico Beach Rd
Road # Belhaven
NC 27810
Township:
Structure:
&NGLF FAMILY
# of Bedrooms:
3
# of People:
6
*Water Supply:
PUBLIC
"Site Classification: N/A
Saprolite System? 0 Yes X No
Design Flow: 3 6 0
For Office Use Only Page t of
*CDP File Number 123283-1
County ID Number: 7610656332
Fvaluated For: REPAIR
PERMIT VALID UNTIL: 0 9/ 1 8 1 a 0 1 8
❑ Open Pump System Sheet
Property Owner: Mary McDonald
Address: 5616 State Hwy DD
City: Fetus
State /Zip: MD 63028
Phone #:
Property Location & Site Information
Subdivision:
Directions
Pamlico Beach Road East
Phase: Lot:
Minimum Trench Depth: a 4 Inches
Maximum Trench Depth: a 4 Inches
Soil Application Rate: Minimum Soil Cover: Inches from
"Natural Ground Level"
'System Classification /Description: a Inches
TYPE II A. CONV SYSTEM (SINGLE- FAMILY OR 480 GPO OR LESS) Maximum Soil Cover: "Natural Ground Level"
'Proposed System: CONVENTIONAL
Nitrification Field 3 6 0 Sq- ft.
No. Drain Lines 3
Total Trench Length: 1 a 0 ft
Trench Spacing: 9 Q Inches O.C.
Feet O.C.
Trench Width: 3 0 Inches
_— — ® Feet
Aggregate Depth: 1 a inches
*Distribution Type: GRAVITY - PARALLEL (eq. d -box)
Septic Tank: 1 0 0 0 Gallons
Pump Required: 0Yes (& No
Pump Tank: Gallons
Grease Trap: Gallons
Septic Tank Installer (g I Oil 0111 0 IV
Grade Level Required:
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.
"Permit Conditions Pump and crush existing tank; backfill with sand; set new 1000gal tank and distribution box; install
all piping and 3 lines (3'x 40') conventional rock trenches for repair; use soil cloth; maintain setbacks
This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not to exceed five years, and
may be issued at the same time the Improvement Permit issued (NCGS 130A- 336(b)). If the installation has not been completed during the period of validity of the
Construction Permit, the information submitted in the application for a permit or Construction Authorization is found to have been incorrect, falsified or changed, or the
site is altered, the permit or Construction Authorization shall become invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system
shall be responsible for assuring compliance with the laws, rules, and per t conditions regarding system location, installation, operation, maintenance, monitoring,
reporting and repair (1938(1 J j .0 A — I
*Authorized State Agent: 2018 - Hager, Matthew /vwxr , /AlK *Date of Issue: 0 9 1 1 8 l a 0 1 3
10 Han( Qfrawing Q Import Drawing * *Site PlanlDrawing attached. **
Malfunction Log Oyes Total Time:(HH;MM)
Activity Code: 0 Hours 0 Minutes

09 -18-2013
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