OPHARNETT COUNTY HEALTH DEPARTMENT NO 1 6 0 8 6
ENVIRONMENTAL HEALTH SECTION
OPERATIONS PERPOV
Name: (owner)
ew Installation
Septic Tank
Property Location:
SR# a ~
Repairs
itrification Line
Subdivision
Lot #
TAX ID# Quadrant # _
Contractor: C /&rJ PG= rCLR- Registration #
Basement with Plumbing: Garage:
Water Supply: Ef-Well Public (3 Community
Distance From Well: ft.
Following are the specifications for the sewage disposal system on above captioned property.
Type of system: Conventional ❑ Other
Size of tank: Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _ of each ditch ft. ditches ft. ditches !Ca in.
French Drain: Linear feet
Date: Z i 2ac,7
PERMIT NO. Z'ZZO Inspected by:
Env onmental Health Specialist
F
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