IPAC original;-; y�-
HARNE COUNTY HEALTH DEPARTMEi
No '
IMPROVEMENT PERMIT f—s
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) 5 fe ✓c' ,Yiisg d(fe Zf New Installation Zf Septic Tank
Property Location: SR#/1/ Z S ,�rr�/rP /i Repairs ❑ p Z3 Nitrification Line
Lot #
Tax ID # Quadrant #
Number of Bedrooms Proposed: Lot Size: s
Basement with Plumbing: ❑ Garage: ❑
Water Supply: ❑ Well Public ❑ Community
Distance From Well: 56 ft.
Following is the minimum specifications for sewage disposal system on above captioned property. Subject to
final approval. I,
Type of system: P, Conventional ❑ Other
Size of ns Pum Tank: gallons
Subsu ce No. of exactlength _ width of
Draina a Field ditches of each ditch ft. ditches ft. ditches in.
Frenc Drain Required: Linear feet
� 2 � Date:
This ermit is subject to revocat'
plans rintended usd Signed: c C I a
Environmental
Health Specialist
ooal�C 7 i*JG�
J!;. cnr
5}}EJf ri1 f�
+D U r r. �( T 5/ S
10,
7
0"- a/- a//6 S Z
kRNETT COUNTY HEALTH DEP RTMENT
AU ><HORIZATION TO COoSTRUCT
Authorization is hereby given to construct a wastewater system to the specifications described
by Harnett County Health Department Improvement Permit # /,T `/'ff . 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.
Owner or Authorized Agent
Name: ✓Tey ,4. Telephone # _ 53—Z- Zia (o
Address:
C.
Property Location: SR # /�/Z 5� Road Name Ahs
—
New Installation
Subdivision
Repair Septic Tank Nitrification Lines
Number of Bedrooms Proposed:
Basement With/Plumbing _
Water Supply: Well Public
Lot #
Lot size: 3-117
Without Plumbing
/
`� Minimum Well Setback: S-'�p
Type of System: Conventional �/ Other
Tank Volume: Septic Tank I&CO gallons Pump Chamber
Nitrification Field Specifications
Number of fields Number of Lines per Field Length of lines
Width of ditches ft. Depth of ditches inches
French Drain: Linear feet required Depth of gravel
ft.
gallons
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.
Authorized Agent for Harnett County Health Department
Name: Date:
(Revised 2/96)CNSTRCT.wro