HomeMy WebLinkAboutIPAC/ , f HARNETT COUNTY HEALTH DEPARTMENT
HTE C� `�' S - i r 3�� �t ' 20860
Bert 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 He th Department."
� c ame: (owner) l CS-New Installation I Septic Tank
Property Location:
SR# i Repairs <itrification Line
Subdivision s Uinc( Lot # f �,
Tax ID # Quadrant # 36 Number of Bedrooms Proposed: X.1 °i Lot Size: A
Basement with Plumbing: 0 Garage:
Water Supply: L7 Well APublic L'1 Community
Distance From Well: ;S� ft.
Following is the minimum specifications for sewage disposal system on above captioned property. Subject
to final approval.
Type of system:
Size of tank:
Conventional
Septic Tank:_ 1000 gallons
Pump Tank: gallons
Subsurface No. of ff exact length width of depth of
Drainage Field ditches t of each ditch ft. ditches ft. ditches in.
French Drain Required: Linear feet
Date: D-1 -Cy-) - --)'f
This permit is subject to revocation if site Signed:
plan or intended use change. Envi onmental Health Specialist
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HARNETT COUNTY DEPARTMENT OF PUBLIC 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 # _ 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.
P , ► n
111ro c-C
Name
Address
I �4(
Property Location SR#
{d3
Lot #
b��--)
# Bedrooms Proposed
Telephone #
Road Name
�3s��
Lot Size
TYPE OF SYSTEM
New Installation [ ] Repair —T� Septic Tank VNitrification Lines
[yonventional [ ] Other
[ ] Basement [ ] With Plumbing [ ] Without Plumbing
Water Supply: j ] Well [ ] Public Water Supply Minimum Well Setback: 5
____-- ---Ft.
Septic Tank 1 gal Pump Chamber
gal
NITRIFICATION FIELD SPECIFICATIONS
Number of fields # of lines per field ______.- Length of lines @2J
Ft.
Width of ditches $. 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.
Signature
Authorized Agent for Harnett County
Date