ETHTE# - 5-. n-3y
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEP'T'IC SYSTEM INSPEC'T'ION
NAME :}t6- )R~r PHONE # yf 9-- yS 5 = 5-15
/
ADDRESS 2 0 - e-Qt ZI 7/ /~a~~~✓ A/ - C. - Y 335
NAME OF MOBILE HOME PARK OR S/D h C = C /
NAME OF OWNER (IF DIFFEREN7) /ZzCj!L72 , CMG' C
ADDRESS OF OWNER (IF DIFFERENT) V& S-- I ~ iZZ~ A) : 7"7 S Z
PROPERTY LOCATION: STATE ROAD NAME AND # /5-x 3 L(
PURPOSE OF INSPECTION:
The aforementioned site has been evaluate byte acne oun y ea epartment
Environmental Health Section. At the time of inspection, there' appeared to be a septic
system serving this site. If this system should 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 5r FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
5 -'-t - t Zr
ature of Environmental Health Specialist Date