IPACHARNf- - T COUNTY HEALTH DEPARTMEr-
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IMPROVEMENT PERMirt
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) r/Y) I k <-4~
E3-1~ew Installation E3Septic Tank
Property Location: SR# , L"1 _ ~ r ❑ Repairs Elf4itrification Line
Subdivision l
Tax ID #
Number of Bedrooms Proposed:
Basement with Plumbing: ❑
Water Supply: (J Well Public
Distance From Well: Y_~ ft.
Lot _ /0
Quadrant #
Lot Size: 3 - c
Garage: ❑
❑ Community
Following is the minimum specifications for sewage disposal system on above captioned property. Subject to,
final approval.
Type of system: ❑ Conventional EY-Other cZ Y,& ke 4-A SVJ4
Size of tank: Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ZOO ft. ditches _,7 ft. ditches t in.
French Drain Required: Linear feet
This permit is subject to revocation if site
plans or intended use change.
Date: !2 fG z
Signed:
Environmental Health Specialist
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HAS Tr COUNTY HEALTH DEPARTMENT; -
AUThoRIZATION TO CONSTRUC
Authorization is hereby given to construct a wastewater system to the s cifications described by
Harnett County Health Department, Improvement Permit ~ ( ~ 7.217 This
authorization shall he valid for a period not to exceed five (5) years from the date of issuance.
This authorization will be invalid if ownership, site plans, or intended use changes
Name Telephone #
Address
Property Location SR# Road Name
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V
Subdivision Lot # # Bedrooms
Proposed Lot size
TYPE OF SYSTEM
[ew Installation [ J Repair k1f Septic Tank [-T-Nitrificiation Lines
[ J Conventional OtheraL- L-;4 , V t' [ J g ~ [ J yPrth Plumbing [ J Without Plumbing
Water Supply; [ J Well [~blic~- Minimum Well Setback: Ft.
Septic Tank 60U Pump Chamber
NITRIFICATION FIELD SPECIFICATIONS
Number of fields # of lines per field Length of lines ~ Ft.
Width of ditches fL Depth of ditches _j L- Z inches
French Drain: Linear feet required Depth of gravel
No wastewater system shall be covered or placed into use by any person until an
[has nspection by the Harnett County Health Department has determined that the system
been installed according to the conditions of the Improvement Permit and that a
valid Operations Permit has been issued.
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gnature o Authorized Agent for Harnett County Date