ET RHTE# a? -s - Zz9i7,Z
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 5/ 1i- -7 -7 Z
ADDRESS - 3°1 t Z u . , , , IZ,-,4 N c Z~ two
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7) ~ NC 71a A) Z7s-/
PROPERTY LOCATION: STATE ROAD NAME AND # 9;jy Z i o
PURPOSE OF INSPECTION 1 ± r 5 ~I
The aforementioned site has been evaluat byte arne 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
of Environmental Health Specialist
/I Z S--C)
Date