ETHTE# 69- 5-- ZZG 77
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~)tr.5 PHONE 868 - R187
ADDRESS Sb9/ &Et1s U+ /0 Z7- -Z(.,
NAME OF MOBILE HOME PARK OR S/D S 6ten_ e 6, _3
NAME OF OWNER (IFDIFFERENT) ~%gdjn~ f Cr~_v7~-_Lkt
ADDRESS OF OWNER (IF DIFFERENT) 1(%4Tes C4,/ .,GEC I'V /).C. Z 75'Z4,
PROPERTY LOCATION: STATE ROAD NAME AND #/yes'/T fS C,~
ZY X 3L ~~,~o~4,sl~c~
PURPOSE OF INSPECTION;
The aforementioned site has been ova uet y t e acne oun ea Department
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
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Sign re of Environmental Health Specialist Date