ETP
HTE# 0~- Y,),D -I ~ yL/ ~
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
NAME O-e I A/\ PHONE #
EXISTING SEPTIC SYSTEM INSPECTION
ADDRESS 161 C le
C
NAME OF MOBILE HOME PARK OR S/D Z~. , d r~ ( Are c ! ~c~ *-S Z Z~
NAME OF OWNER (IFDIFFERENT) C f , (21 Scrz 5
ADDRESS OF OWNER (IFDIFFEREN7) j 0 1 0,,, 7" d1z fn, PROPERTY LOCATION: STATE ROAD NAME AND # -±L L-2
The aforementioned site has been evaluated by the Harnett 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-11
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 MUS BE 5' FROM ANY PART OF SEPT' TSYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
~ ~ L=yl
Signature of nvironmental Heal
0Z
specialist
Date