ETHTE#.p -s = 2y46
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME _ ,Ze SU' •41C 1o S PHONE # 914' '4~68 -787 .
v
ADDRESS 2 3 0 (;;fi L r' ,60,y, j A). C. 2 ~.33y
NAME OF MOBILE HOME PARK OR S/D ~'0- f~
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE OF INSPECTION:
The aforementioned site has been eval ated by the Harnett County ea 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
111 /4 'e- '46'~5p-3
of Environmental Health Specialist
Date
-/0