ETHTE#,ZO, 1157
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME r,, ~au (n,,o PHONE # -"Y3 7
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ADDRESS 135 f r2~s, ( t_ ~/a✓► a,,
NAME OF MOBILE HOME PARK OR S/D (j 0 k c,
NAME OF OWNER (IF DIFFERENT) 0 0 k , t rv~ C ~
ADDRESS OF OWNER (IF DIFFERENT) S ram.
PROPERTY LOCATION: STATE ROAD NAME AND # c l1rt,~
PURPOSE OF INSPECTION: 7 , h J z
The aforementioned site has been evaluat by t e arne oun y 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.
ot4-14Ao") leJ hA,C (j- crn ,n
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or -
1-f~ S~►ow' %G~~
(2) the system should fail or malfunction, and/or
(3) the owner or tenant of the property changes, and/or A(U, uJ, r j
(4) after six months 4 K3 ~ rd i!h ~BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
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Signature of E vironmental Health Specialist Date