ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME r~r►+~., ~ ~.5~>~adc `t PHONE # ~/`1-°77S' z
ADDRESS Vi`i' 3 (f~~~1 C . `2 "Z t-0,~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE,OEINSPECTION: GA:~~ .rI',
The aforementioned site has been evaluated by theme- arnet~~~oun- y eeaTfh Department 3a
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
.o
any necessary,
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 OF SEPTIC SaYSTEN!
D®, NOT DRIVE OR PARK ON 'SEPTIC SYSTEM - AUTHORIZATION OF EXISTING SYSTEM
-Zi 1'Z
of Environmental Health Specialist Date