ETHTE# 12 - -:T - Z`~) c 8
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME f3--u.r-t f- ° U PHONE # 96 3&5 - 3`300
ADDRESS /Y Z/ r- i3Ac _ 3-j 7 E t,/, L` ' C_ , Z7 5.2
NAME OF MOBILE HOME PARK OR S/D J "-t-
NAME OF OWNER (IFDIFFERENT) t)tt S ,;-j + S &7-/i - ",,7,N4
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
~L. Pt/RPOSE, OF INSPECTION`'
The ~for',ementioned stte:has+een dafuatcd£by t
'v +Kw ;~s f~ .p~ ,r`.-.' ~,NV""`•ae+ ;rr r`:PrJ: d` ..=4~l]''-'~ .S~i.
Environmental tfiealth,Sectioh At the,~~me of ins~e
{m'f'r I S~.s~ t~' ^{'~7' V i t 3 t# r i e y' s' icy
system ser.vkmg+this'-tite.,f this:system should maff~
,ti h}FAr ! y ~1`-S e~, k .r~ r v~ cb$s,
any,~neceSSal~epi
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 PART,0F. SEPTIC SYSTEM'-,''-' DO NOT DRIVE OR PARUN SEPTIO}SYS,TENR
arnet£ bun yLFiea~th department j,
ton, (here appyeared toe aseptic F
~n,ction, the ov ner,,Cs responsible for
AUTHORIZATION OF EXISTING SYSTEM
S.
of Environmental Health Specialist
Date