ETHTE# d`' s' - Z/s"o
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 7 v 6 C PHONE # 910- SSZ - ZZl7
ADDRESS i Z 17 LIvF_ D~l.~ i2 Ts N c 27SZ
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) ~3e-ftN
ADDRESS OF OWNER (IFDIFFERENT) //f V 77i,~c /J C Z833Y
PROPERTY LOCATION: STATE ROAD NAME AND # 52 / 7 LZ T~i-c« /3.co~cP ~Zc~
PURPOSE OF INSPECTION: Fx~ T,,,,~1f ,Z<_ dSEx Swr►1,~
Th#' aforementioned site has evalua by 0 H~irr~ed u* Nealtf ae ~ rtm
pa sn4.".
Itwtonment, Health sectiOW AI tie thfii 011hspad6k t ore appe ed to
bae a septfid:
system servih this[ sltik it that 4 stem, shoutsra t
ti 1ft~r~cttori the Qvim 1,
at mOonslbie o
_ f n r cesaar rep; r
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
BUILDINd MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
00 NOT DRIVE OR PARR' ON SEPTIC SYSTENt
AUTHORIZATION OF EXISTING SYSTEM .
of Environmental Health Specialist
Z--g-D F
Date