ETHTE# 09-5'- Z239q
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~ ,txx; Poo / Pegs 7- PHONE # Sao -8i'z- 764.5'
ADDRESS ~ ~5- SU D 2b 6 Ultf^J ,~J . C . z 833 ~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) 7/o yCt Lr~Lt /GD F, fi. N• C. Z~s'z~
PROPERTY LOCATION: STATE ROAD NAME AND
PURPOSE OF INSPECTION: sc Yr : ~,z~' 1? ,r I
The aforementioned site has been evaluat y e Harnett , oun ea Department
Environmental Health Section. At the time of Inopectiortj there appeared to be a septic
system serving this site. If this system should malfunctior, 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
/t'P>
of Environmental Health Specialist
/ ( _
Date