ETHTE# - - 4 Y.15-Jr
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME A l; a-4r
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PHONE # q1q, S&g. 41q /
PROPERTY LOCATION: STATE ROAD NAME AND #14) `J- w I-S are h pi,
PURPOSE OF INSPECTION:
The aforementioned site has been evaluate y t e arne oun y7H6-aft 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
4 b 64` d 1/~. 1111~-1q. El 71-6-
Signature of Environm tai ealth Specialist Date