ETHTE# 1 0 - 5-- a5 199-
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME C1 LC'~S E PHONE # ADDRESS 1q41 N(
NAME OF MOBILE HOME PARK OR S/D -T(
l t M CA4tn 1k c')- 7 574 e
NAME OF OWNER (IFDIFFERENT) y-e ( u?mw 1 rl ~j
ADDRESS OF OWNER (IFDIFFERENT) 5,~0 /-6 97k~ . L4-I n
PROPERTY LOCATION: STATE ROAD NAME AND # VV
PURPOSE OF INSPECTION: ~C Q
The aforementioned site has been evaluate by t e acne 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 MUSS' BE 5' FROM ANY PARS` OF SEPTIC :SYSTEM
00 NOTDRfVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
& 9z h ' Hs,
Signature of Environ tal Health SDeci list
Al15-/11)
Date