ETHTE# / s Z/18Z
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /1&,z&j Iylo c~ ~l~ r iZ~ PHONE # cj/ S'- r3/ - 04;8
ADDRESS Zb bAW /?Lw zg~j~ /OC Z7tr-o i
NAME OF MOBILE HOME PARK OR S/D DUX)
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #/ry Z/U
PURPOSE OF INSPECTION. I .,a < 4")✓s~
The aforementioned site has been evaluated byte arne oun y ea DepaAment
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
DES NOT DRIVE OIL PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
5r- Za • d 9
Date