ETHTE# 05 -s -0 35-0'3
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 7-D L 'L -PHONE 0/5-&35 -63e5
ADDRESS 17P5' Aft- .S -26 /77 V. A) - C . 2 -7 S' .7 (o
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # :~7t % V Y(~
PURPOSE OF INSPECTION:
The aforementioned site has been evaluat byte Harnett County 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
Aolj~ 161~
of Environmental Health S
Date