ET RH T E # / Z - t;- Zji-3 Z(/Z
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME riZc(,4.i.,, G.! tt= PHONE #'W 2 3 Z I ADDRESS 70 Aim, W1 J L ~ r~°,
NAME OF MOBILE HOME PARK OR S/D~s~i
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND 5% 3=~C~ ~
, b I CY Tir j~ v
P"PQSE,-OB,IIv SPEC7'ION
. The aforementioned site ha' s beery evaluated ytt Hi et~oun y eaCfh Department
Environmental Health Section: At the time of inspection, there,appeared to be a`Sept~c
system serving this'site;_If this,system should malfunction, the owneris responsible fore;
and necessary re alrs:, u ,
n S`;7 J'`k'3r.,. .,a" k q;,`„ • t' , . ^Y ~ r'S s,X+,y.a, ~ ,<,e ? aitY`y'}~ f. 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
BUILDING MUST BE 5' FROM ANYPART O NSEPTIC. SYSTEM
t DO NOT DRIVE OIL PARK ON SEPTIC SYSTEM
~ , ~ - t .~,yr~ 4 i,°~,~ _ Y v4T`~'~ . ~ arc, S•: '~'-,,,.v-; t.a a+t~5 tr's ~ ~k.' g r"' y "]''~y~ ~i-, a+~y.tY jrK'_, r ,r .Y "-r.u. ~S {',Ea _
AUTHORIZATION OF EXISTING SYSTEM
o,"5/y-5
re of Environmental Health Specialist
-2i
Date