ETH T E # /Z- _ Z IPI
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # ADDRESS 79:r ~4z d IZ.~ iJ~z- fZ `
NAME OF MOBILE HOME PARK OR SID ~NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREND -3 p ~;`w. -r te l , - tU
0
PROPERTY LOCATION: STATE ROAD NAME AND
The aforementioned site:has been evaluated by the Harne oun~y ea h Dpartment s
Environmental Health Section: At the time of inspection, there appeared i6'66', a septicr-r~
system serving thissite If th~s;system should.malfunction, the owner is responsible far;
t
anyecesssry srepairs:
a i'~r a ! "'as. s =gA:fY 3 ! r 4;~tro~d
« ..,.~.d, .r.. .r..i.,i.~.rt - 1$`v'?2'.
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or
(2) the system should fail or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
~41
,w BUILDING MUST BE 5" FROM ANY PARS` OF SEPTIC SYSTEM I
D0,' NOT DRIVE OR. PARK ON SEPTIG{SYSTEM <F
4^:w"x,= ,y'-_ ;~~s y. .m„_'&'.; ..ee,•~,+. ag .s,,j ~~~r,; ey ,.i y~~. rtr~~ a; a.. .%.tr, v{"a. y~Sr
AUTHORIZATION OF EXISTING SYSTEM
cc,'_ 1 , `h-S
of Environmental Health Specialist
Date