ETHTE# 09 -S-- 2 2 91 -7
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME , fj yT 5 PHONE # g- 71 Z- 5`703
ADDRESS 39/2
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NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) /,,1 Z~~
ADDRESS OF OWNER (IF DIFFERENT) 65-63 N.C. Z/a ,J 4-'"Aa " /13'e- -Z7~o!
PROPERTY LOCATION: STATE ROAD NAME AND # f Fz .a
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated by the arne County Health 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
rhv !d - -7 '0<I
ture of Environmental Health Specialist Date