ETHTE# Ln- 2z41s-
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME / PHONE # _Ylf- 77Z- gy33
ADDRESS 31.1 b S, C.J c/mr,t /~J S T A)
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT) X85-5 D/D 994E5-PROPERTY LOCATION: STATE ROAD NAME AND # -5 ~
PURPOSE OF INSPECTION: . ~ `1~r"~
The aforementioned site has been evaiuat t e arne 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
ature of Environmental Health Specialist
o-
7- D S
Date