ETHTE# 16 -5"- 235 73
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME by ,Qx ~LJil c~_r PHONE # f 1c, - 95 Z- .Tz yS
ADDRESS ° b 5 /,J *z,2 D r-n~ N C- ZQ 3 3 2-
NAME OF MOBILE HOME PARK OR S/D O /q-r<
NAME OF OWNER (IF DIFFERENT) 11'~nbh 5
ADDRESS OF OWNER (IF DIFFERENT) _g0 36y N c Z fi'3~ y
PROPERTY LOCATION: STATE ROAD NAME AND # vt - Z2L9 /0,0
PUB_POSE OF INSPECTION: c~L
The aforementioned site has been evaluated by the arne n 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 E TING SYSTEM
3 2 3- to
of Environmental Health Specialist Date