OP originalCv-5 4333
HARNETT COUNTY HEALTH DET iTMENT No- 13 4 611
ENVIRONMENTAL HEALTH SL-fION
OPERATIONS PERMIT
Name: (owner) 5 T e �� d New InstallationSe tic Tank
Property Location: SR# E) Repairs Nitrification Line
Subdivision
TAX
Lot #
Quadrant #
Contractor: Registration #
Basement with Plumbing: ❑ Garage: ❑
Water Supply: ❑ Well Public ❑ Community
Distance From Well: sy r ti•
Following are the specifications for the sewage disposal system on above captioned property.
Type of system: 0 Conventional ❑ Other
Size of tank: Septic Tank: 160— gallons Pump Tank: gallons
Subs
Drai aee Field ditches of each ditch ft. ditches ft. ditches
Drain: _ Linear feet
in.
Date:
Inspected by:
nvironmental Health Specialist