ETHTE# 10-5--23717
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME h yrJ,/~V,rc zl-o co -Y41 41~ PHONE # 4/P- Z -1/ - 56Z f
ADDRESS 116 v,1s-I7
NAME OF MOBILE HOME PARK OR S/D L f -7
NAME OF OWNER (IF DIFFERENT)
,y~~,~
ADDRESS OF OWNER (IFDIFFERENT) Zq.1 B/,pziL 4Dgfit.
PROPERTY LOCATION: STATE ROAD NAME AND #5j /~~/2 D D ,QtIA6.5 c ,peel)
4
PURPOSE OF INSPECTION: r r' X _ 1z ox, x`3' - I Abp ntoxQ_ ¢a w
The aforementioned site has been evaluated byte Harnett oun f-H-ea-ft 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
Z-14--10
Date