ETHTE# Q9- S- Z/~ZQ
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME N1-1
~J~ PHONE #i! X60) 9-3 a- 5~;62
ADDRESS f?p. ~D /857 L~`s'a~ ) ,J (f Z75zf
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) s- on ,5 6o*T5 tz.,D ~GI ~N C. Z ~
PROPERTY LOCATION: STATE ROAD NAME AND
y 45r)-p4- 64q_~ lee
The aforementioned site hay been evaluated by the I'larnett County Health Department
Environmental Health Sectl"on At the thoi of Inspe~tton~ there appeared to be s septla -J
system serving this site. If this system should malfunction; the oHmer is responsible 6'
any,, ecessary 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 Y FROM ANY PART OF SEPTIC SYSTEM'
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date