ETHTE# / b -5--2 3 S fb
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME,~a PHONE # q19 -)?5Y-L,0,6 T
ADDRESS _~o . 8,lr-/ 35 C- 2-75-0
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #,'$t- 1-705
a~.k, Cr/Cff i2~1j
PURPOSE OF INSPECTION: ~ ~39-~-,-~,
The aforementioned site has been evaluat by the acne County Heafth 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
2 4;ZDI~
of Environmental Health Specialist
3-1Z-1b
Date