ET RHTE# 0'-? -5 3J ( _YN I
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~C S L } t11 I ~ •V G-A Sfkn4,',-
PHONE # _
ADDRESS ~ K'~, 6., 0(ot- C+
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) _ 5r4-x~
ADDRESS OF OWNER (IFDIFFERENI)
PROPERTY LOCATION: STATE ROAD NAME AND # l
The aforementioned site has been evaluated by the Harnett County Health 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
DES NOT DRIVE OR PARK ON SEPTIC SYSTEM
L,Vf
or Environmental Health Specialist
AUTHORIZATION OF EXISTING SYSTEM
0_/6-o--?
Date