ETHTE# 0 ) (p 5
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # ADDRESS J3 l ILC~n ~3 3
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) 1v&x
ADDRESS OF OWNER (IFDIFFERENT) 477 C/ 0 d i , , 6wU1(21~~JL
PROPERTY LOCATION: STATE ROAD NAME AND # yQ~La, n0A /-A~ d
PURPOSE OF INSPECTION:
The aforementioned site has been evaluat - e arne oun ea Department
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 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
.s 2
Signature of Environ ntal Health Specialist Date