ETHTE# 61- - 2- Z8875'
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ! PHONE # 5f 9- 753 - 80 13
ADDRESS y6 f3 /Zrr, ~C • 273"L4r
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # /L /Yl Yr ~ re O
PURPOSE OF INSPECTION:
The aforementioned site has been evaluate by a arne oun y eapartment
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 QP SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of
{ '5-- 7-7- 07
virorimental Health Specialist
Date