IPAC RHARNETT COUNTY HEALTH DEPARTMENT
7
HTE f 5__ `f ~ 0" IMPROVEMENT I 2 0 28
Be it ordained 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 Department."
Name: (owner) Lcf 'New Installation Septic Tank
S p
Property Location: Re
airs Nitrification Line
Subdivision Lot #
Tax ID # Quadrant #
Number of Bedrooms Proposed: ( X-Lot Size:
Basement with Plumbing: 0 Garage: [71'
Water Supply: 0 Well ~ Public ~ Community
Distance From Well: t D ft.
Following is the minimum specifications for sewage disposal system on above captioned property. Subject
to final approval.
Type of system: (Conventional C~ Other
Size of tank: Septic Tank: , gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of (k
Drainage Field ditches of each ditch ft. ditches 3 ft. ditches l b 1 "m.
French Drain Required: Linear feet
Date: 03
This permit is subject tol revocation if site Signed:
plans or intended use ch nge.
En ironmental Health. Specialist
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HARI`T.I TT COUNT. HEALTH DEPARTMENT
AUTHORIZATION TO CONSTRUCT
Authorization is hereby
given- to construct a wastewater system to the speciticatimns
. by Harriett County Health Department, Improvement permit # described
authorization shall be valid for a period not to exceed five (5) yea from e - This
This authorization will he invalid if ownership, sitePlans, ar intended use changes to of ~~uance'
Name
12
Property
7n SR#
Lot #
(d, X ~),D}
Bedrooms Proposed
Lot Size
TYPE OF SYSTEM[
New Installation [ ]Repair [ eptic Tank *Nitrification Lines
Conventional [ ] Other
[ ] Basement [ ] With Plumbing ~ [ ] Without Plumbing
Water Supply: [ ] Well _[}~j Public Water Supply Minimum Well Setback: Ft.
Septic Tank
Pump Chamber
NITIRI''ICATIOIdT EIELID SPECIFICATIONS
Number of fields of lines per field
Length of lines l b ~ Ft.
Width of ditches Dept of ditches inches
French Drain: Linear feet required Depth of gravel gmffffiffi~
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 conditi s of the Improvement Permit and that a valid Operations Permit has been issued.
Signature of
Agent Harnett County of Harnett i 10
RoadNamec~
Date