ETHTE#Q~- 5-- ~-7
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME S PHONE #(q/V Ss'Z - ~~Sy
ADDRESS 27 (P C 1 ~r,Ce 5 c~ Gi + AVAI fir,
Z?sy
NAME OF MOBILE HOME PARK OR S/D~L,J /3 ~tn~~n l ref y h
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # L42- C/9721kiS CIO r2
PURPOSE OF INSPECTION
The aforementioned site has been evaluated byte Hatnett Coun-fy-ffe-a-ffh 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
/O-z/--
of Environmental Health Specialist Date