ETHTE# /0 -S'= Z y`~
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME h~aw PHONE # /9/`) - 9ZY-/yZZ
ADDRESS 80 4.14. ~ tar/ rL-7s"zt
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 119*t/1fZS C41-C
6 4
PURPOSE OF INSPECTION:
The aforementioned site has been evaluate y the arne oun 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
I i ,.L
of Environmental Health Specialist
Date