ETHTE# o-1_5''2Z7y9
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME __i1 Cj <<~ F%; 1 o t PHONE #
ADDRESS ,Z T
j
NAME OF MOBILE HOME PARK OR S/D L I r- L'
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 2,q
PURPOSE OF INSPECTION:
The aforementioned site has been eva uat y t e acne oun ea Department
Environmental Health Section. At the time of Inspectlont 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
XUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
z ~ Lea
Date