IPAC R&,-72r 5'- y/ O
- LIJ Z1 VAN 9 1110 l
Authorization is hereby given to construct a wastewater system o the s eeifications described by
Harnett County Health Department, Improvement Permit # )2 . 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 0 Telephone #
Address
Property Location SR# Road Name
TYPE OF SYSTEM
[ 4-jie-w Installation [ l Repair [ fsej�k Tank [ fNitrificatiou Lines
[ onventionalOther,
[ ) Basement [ ) With Plumbing [ ] Without Plumbing
Water Supply: [ [ ] Public - Minimum Well Setback:. Ft.
j CATION FIELD SPECIFICATIONS
Number of fields # of lines per field Length of lines 13 3 Ft.
Width of ditches 3 fl. Depth of ditches --C 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.
12�
of Authorized Agent for Harnett County
Date