ETHTE# 07-S -1,,?, '4
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE
~~~~a
ADDRESS A1(?
NAME OF MOBILE HOME PARK OR SID 0 Pa1 k L- ~ 5 j
Aa~_ 1
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) ~S /5tkUS&,, t &
PROPERTY LOCATION: STATE ROAD NAME AND #
The aforementioned site has. been evaluated by the Hamett County Health Department'
Environmental. Health Section. At the time of Inspectlok there appeared to be a septic
system serving this site. If thls `system should malfonctl'", 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
BUDDING MUSS' BE 5' FROM ANY PARS` OF SEPTIC SYSTEFA
DO NOT DRIVE OIL PARK ON SEPTIC SYSTENH
AUTHORIZATION OF EXISTING SYSTEM
&t,i l ,l _ V xf Signature of Environmenal Health Specialist
3_0
Date