ETHTE# n9- S- z,Z37-i
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME - PHONE #Zj?"
ADDRESS _f- D . "6 /y/0 e!54: ~ A) . G . -g-75-01
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #l~/ ~j ~Q
5,-4411
PURPOSE OFINSPEETION: ~ ` ?A , ~SZnt1' P;E
The aforementioned site has been evaluated by t e arse oun ea Department
Environmental Health Section. At the time of Inspectlon 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
AUTHORIZATION OF EXISTING SYSTEM
2
-7-1
Environmental Health Specialist Date