ETHTE# /Z_- - Z6-SA
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME S / A> c"fir PHONE # Z
ADDRESS '17-2 W fek-, 12;1) ,Z c ~3 ,0 L~- Z 55~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) rtr~= ~ti /12~
ADDRESS OF OWNER (IFDIFFERENT) 3-7-5r-
PROPERTY LOCATION: STATE ROAD NAME AND # 5Z / 60c> &.6 e 5 j,e-b
PURPOSE, OFINSPECTION:
The aforementioned site has been evaluat-6d by tH-e-H arneft My-ff ea Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site: If this, system sh"ould malfunction, the owner is responsible for
any necessary repairs.
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,,ANY'PARTOF,SEPTIC SYSTE. M
DO NOT DRIVE OR PARIS ON SEPTIC: SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
11~17F 11157
of Environmental Health Specialist Date