ET RHTE# / - 15--- 37-7 -C,5g
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /�(/� �_ PHONE #
ADDRESS 7 Lt /i`� cJ(L . it f=o Gam,
NAME OF MOBILE HOME PARK OR S/D 1.-;;04 j�n
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # e:>01t5Z Ba-& ll,D
din zs�
PURPOSE OFINSPECTION
The aforementioned site has,$een evatuat� by the w acne aun y ea Department ,i
Envirdnmenta Heath Section: At ilhitt' a of i`n'sp ctlYotlyrtfiere appeared tt tie a'septlsi
system serving tfils site, If this system should malf6ri.diorl, the owner fs responsible for
any necessary l�epairs3
;, r c,T r> r...
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