ETHTE# - = ZK-7`/
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAMEi PHONE # i~ - `r 5 r 7
ADDRESS -5ttf 5:~~azc~ , Z 7> L Cr-
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #,~ZA-IC
1
1 '7
PURPOSE OF.INSPECTIONr 7 ~.T -
The aforemontion d sit' hai been a aluat eRarne au`n y ea h Department
Health Section: At the time of"inspect on; there appeared to, be aseptic--
Environmental'
system serving this-site', If this,system should malfunction, the awnerls'responsihle for";
necesµary fepaIrs` W ' j
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
BUILOING MUST BE 5' FROMIANY PART OF, SEPTIC. SYSTEM
~>n L { DO NOT DRIVE QI PARK Q[ SEPTIG~ SYSf EIV 1
~g o k._9..K.
AUTHORIZATION OF EXISTING SYSTEM A
of Environmental Health Specialist Date