IPAC RROrtt RCS HA. SETT COUNTY HEALTH DEPARTNT N`
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Be it ordaine by the Harnett County Board of Health as follows: Section III, Item B. "No Person shall begin construc-
tion of any building at which a septic tank system is to be used for disposal of sewage without first obtaining a written permit
from the Harnett County Health Deprtm~nt." F
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Name: (owner) ~ ~a 0 f ew Installation Septic Tank
Property Location: SR# ? ❑ Repairs --,0 Nitrification Line
Subdivision
Lot #
Tax ID # Quadrant #
Number of Bedrooms Proposed:_. Lot Size:
*3 'y
Basement with Plumbing: ❑ >`S Garage: ` F ~ n``.-.
Water Supply: ❑ well" Public ❑ Community;
Distance From Well:
Following is the minimum specifications for sewage disposal system on above captioned property. Subject to
final approval.
Type of system: ❑ Conventional Other
Size of tank: Septic Tank: ' gallons Pump Tank:' gallons
Subsurface No. of,. exact length width of depth of
Drainage Field ditches of each ditch ft. ditches ft. ditches in.
French Drain Required: Linear feet K4 #
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Date:
This permit is subject to revocation if site Signed:
plans or intended use change. Environmental Health! Specialist
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*ETT COUNTY HEALTH DEPT M
AUTHORIZATION TO CONSTRUCT
Authorization is hereby given to construct a wastewater system to the specifications described by
Harnett County Health Department, Improvement Permit 19 Lr) ~y . This
authorization shall be valid for a period not to exceed five (5) years from the date of issuance.
This authorization will be invalid #"ownership, site plans, or intended use change-
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Address
Property Location SR# Road N
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ivision
Lot #
# Bedrooms opos
Lot size
TYPE OF SYSTEM
New Installation [ ] Repair N171eptIcTank KNitrificatiom Lines
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f ] Conventional Other _ V "~'n
[ ] Basement ( ] With Plumbing [ ] Without Plumhing
Water Supply: [ ] Well [ blic - Minimum Well Setback. 5D Ft.
NTTI MCATION FIELD SPECIFICATIONS
Number of fields # of lines per field 9Length of lines t4 Ft
Width of ditches -3 ft. Depth of ditches 17 inches
French Drain: Linear feet required Depth of gravel
No wastewater system shall be covered or placed into use by any person until an
inspection by the Harnett County Health Department has determined that the system
has been installed according to the conditions of the Improvement Permit and that a
_ valid Operations Permit has been issued.
Sipature Authorized Agent for ftarnett County
Date a 1/r