ETHTE# A) - 2 y(4 y3
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME by L PHONE # 91 Y - 01V- 3323
ADDRESS 13 8 Co,2,a tic/I PA ,C3 l~ C . 2-Z 5-0 y
NAME OF MOBILE HOME PARK OR S/D (,J~l (ut,J 13200 GL L&-4-1(4
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # _~;e j"l /3~(c~.. s C,tass za s
PURPOSE OF INSPECTION- ~E r3tr~ ' ~'r vrr~ !n e c f'Q app
The aforementioned site has been evaluated by the Harnett Couhly-ffe-alth 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 EXISTING SYSTEM
S' ature of Environmental Health Specialist Date