IPAC RHARhj'' T COUNTY HEALTH DEPARTM(- T
HTE# O1-S--)3 u, it0P
IMPROVEMENT PERMIT 2 2 716
Be it ordained by the Harnett County Board of Health as follows: Section III, Item B. "No person shall begin
construction 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) New Installatio4391 Septic Ta
nkZ Repair ❑
Property Location: SR#C ? Nitrification Line -A Expansion ❑
Subdivision /-a (1c Lot #
Tax ID# Quadrant #
Number of Bedrooms Proposed : Lot Size: r ~ A c
Basement with Plumbing: ❑ Garage: ❑
Water Supply: ❑ Well Public ❑ Community
Distance From Well: ft.
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: tJ gallons Pump Tank: gallons
Subsurface No. of exact length
Drainage Field ditches _ ft. of each ditch
French Drain Required:
This permit is subject to revocation if site
plans or intended use change.
Linear feet
width of depth of
ft. ditches ft. ditches in.
Date: t~ y
PERMIT EXPIRES 5 YEARS FROM ABOVE DATE
;ntal Health Specialist
`.X
- - y 1 1 v 1 I IJEYAK I NIEN T OF PUBLIC HEALTH
AUTHORIZATION TO CONSTRUCT
Authorization is hereby given to construct a wastewater system to the specifications des
Harnett County Department of Public Health, Improvement Permit # cubed by
authorization shall be valid for a period not to exceed five 5
) years m the , .`this
This authorization will be invalid if ownership, site plans,(or intended use cdate of issuance,
hange.
Name
Address
~0- ~ -I
Prooperty Location SR#
/ >l e J A(L
Subdivision
3(1 yi-73) ot"~
# # Bedrooms Proposed
TYPE OF SYSTEM
Lot Size
~fJ New Installation [ ] Repair Septic Tank
Nitrification Lines
[ ] Conventional -Other
[ ] Basement [ ] With Plumbing [ ] Without Plumbing
Water Supply: Well 'Public Water Supply Minimum Well Setback: 643
--~_Ft.
Septic Tank gal pump Chamber app
gal
Number of fields # of lines per field
Length of lines ~
Ft.
Width of ditches ft. Depth of ditches
inches j-` J,-c41~ ✓t
French Drain: Linear feet required Depth of
gravel
No wastewater system shall be covered or placed into use b any persn uil an Harnett County Health Department has determined that the system has b en installed ctcordi y the
the conditions of the Improvement Permit and that a valid Operations Permit has been issued. to
.
Signatu
Ln lJ~s- ~2s
"u«iviiLcu agent ror Harnett County
Telephone #
Road Name
Date