ETHTE# & - s7-Z:5-76
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
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NAME CRxa/r,,, g PHONE # ADDRESS q 2q 1) CZ7R13
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) SrZy,,-:fiJ
ADDRESS OF OWNER (IFDIFFEREN7) /20 &.IQ A) C Z&ff
PROPERTY LOCATION: STATE ROAD NAME AND # -:st /-70 7 w~ ~,r,F,•~,~s
PURPOSE OF INSPECTION; G rea The aforementioned"site has been evaluated by the arne ou y 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
ature of Environmental Health Specialist
C Z,1/a
Date