ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME IN,,-4 ~ o k ANc GSA S n ~-N H PHONE # ci 15 - a0 ~ ~ 56 Li4
ADDRESS PO X Z .53 J N LEYGL - -IrZI31)3
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # `-)~O Md-EP,N C,AP1F%L C*QD
PURPOSE OF INSPECTION:
The aforementioned site has been eva uat 11,
y t is erne 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
ORIZATION OF EXIST IN G SYSTEM
Z5
Signature of Environmental Health