ETHTE# /U-5 = Z 3906
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME A4!'- + nj PHONE # N& - y!/- 5`~i/
ADDRESS RG 3 ~W
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) ~fyS"" ~Il~., ~Ur~i✓ Nr. Z833'p'
PROPERTY LOCATION: STATE ROAD NAME AND # 57f /?95'i4i~24-i-j 106 17'- 3r) / S
PURPOSE OF INSPECTION: -
The aforementioned site has been evaluat byte Fa-m-eft-C-ou-nTy-Welaffi Department
Environmental Health Section. At the time of inspection$ there appeared to be aseptic
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
/5--/ 6
Date