ETH T E # /b-5 -2If835-^
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME J<er -Q- f(od / ,;/We,, PHONE #q/ -yZ7- y6Z8
ADDRESS 7Z o vGL/ook Cr- A2-C,
2-t s b r
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)riz
ADDRESS OF OWNER (IFDIFFERENT) Vv
PROPERTY LOCATION: STATE ROAD NAME AND # Z/o nJ
PURPOSE OF INSPECTION. 12 c- I f L L.~ r
The aforementioned site has been evaluated by the arne oun y ea Department
Environmental Health. Section. At the. time of inspection, there appeared to be a septic
system serving this site. ff 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
of Environmental Health Specialist
Date