ETHTE# / _5 - 37182.
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 6!ay/Z4W E±n4 PHONE #
ADDRESS 2-31t3 /yvkt,sm.(
NAME OF MOBILE HOME PARK OR S/D 4N0'2-
NAME
N Z
NAME OF OWNER (IFDIFFERENT) /</' f/Ce((c,
ADDRESS OF OWNER (IF DIFFERENT) Y09
PROPERTY LOCATION: STATE ROAD NAME AND # Ss�yS6 /�i//:nc�QiUJ
PURPOSE OFINSPECTION
Tt__'�4�L __ aiY�va .t�:};':",r., . . IY� J. tt. •a �—� _.......
this sysfem should'i lalf6d16 f, the owner is;respons!bib fol
.44.
ynecessaytepa(rs
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::" -
of Environmental Health Specialist Date