IPAC RHTE HARNI, I,' COUNTY HEALTH DEPARTME 20544
IMPROVEMENT PERMIT
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 , ew Installation Septic Tank
Property Location: SR #_ ls10 % � �, P RX 0 Repairs MKitrification Line
Subdivision i : Lot #
Tax ID #
Quadrant #
Number of Bedrooms Proposed: Lot Size: . d M C
Basement with Plumbing:
Water Supply: 0 Well
171 Garage:
0 Public 0 Community
Distance From Well: aro .� - ,— ft.
Following is the minimum specifications for sewage disposal system on above captioned property. Subject
to final approval. /'�
Type of system: 9 Conventional 171 Other
Size of tank: Septic Tank: /MO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches_ of each ditch "Zr ft. ditches 3 ft. ditches l -),P4 in.
French Drain Required: Linear feet
Date: A/acov
This permit is subject to revocation if site Signed: . =f
plans or intended use change. Environmental Health Specialist
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HARNETT CC 4TY DEPARTMENT OF PUB: ;HEALTH
AUTHORIZATION TO CONSTRUCT
Authorization is hereby given to construct a wastewater system to the specifications described by
Harnett County Department of Public Health, Improvement Permit # R Q 5-qQ) . This
authorization shall be 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 change.
Name
Address �—
Telephone #
1�7 c� �� ,� e Kj
Property Location SR# Road Name
rt �ry
Subdivision Lot # # Bedrooms Proposed Lot Size
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TYPE OF SYSTEM
[,'New, ,Installation [ epair [ eptic Tank [ Nitrification Lines
Conventional [ ] Other
[ ] Basement [ ] With Plumbing [ ] Without Plumbing
Water Supply: [ ] Well
Septic Tank /OQ 0
[- 1'15'ublic Water Suppl;T Minimum Well Setback: J--C� Ft.
gal Pump Chamber
NITRIFICATION FIELD SPECIFICATIONS
gal
Number of fields ® # of lines per field Length of lines 7j— Ft.
Width of ditches ft. Depth of ditches 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.
of Authorized Agent for Harnett County
/,2-, -V
Date