ETHTE# 2Z-77 v
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME _ L~,~ ls,J ycy~ PHONE #'i"6-639- .S"ZaZ
ADDRESS z/1 Fem. Q~-c N • Z'1 s o
NAME OF MOBILE HOME PARK OR S/D
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NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) 17-o ~ ins 5T J - c . ZKG y<
PROPERTY LOCATION: STATE ROAD NAME AND #
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PURPOSE OF INSPECTION;
The aforementioned site has been evaluated by the HArne!FC-du-n-tVTFe-affh 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
of Environmental Health Specialist Date