ETHTE# 07-5-IPY-5 Z
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ,~.A._ <iv o4, j qii~rQ
PHONE # f19 - s 77 - 6 Q?y
ADDRESS ~e -7-~ I/ C s , L l 2D F V ns . C 7-7 5- Z CP
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFERENI)
PROPERTY LOCATION: STATE ROAD NAME AND # a/G/y/Z
The aforemen#ioned site has been evaluated by the.Han ett, County Health Department-:
Environmental Health Section: At tht time of inspecd6% there appeared to he a septic ~ k.
system serving thie site. If tfiie system should maifunctlor, the owner is responsible fori,
any necessary repair
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 T FROM ANY PART OP SEPTIC SYSTEF&
DES NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
IZ-17-o
re of Environmental Health Specialist Date