ET RHTE# —S -3707/ZIZ
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 91 F - j2e1-7/S S
ADDRESS /61 'J Agd' /2z blx" n
NAME OF MOBILE HOME PARK OR SID
NAME OF OWNER (IFDIFFERENT) gyp_ ft,g/�►cicm.s�
ADDRESS OF OWNER (IF DIFFERENT) IJP C • Z W 3.3 y
PROPERTY LOCATION: STATE ROAD NAME AND # 6(?- / #a2
s , ,
The aforentenh�n6ecCsit� �s been evafuatet .y',t e4 acne County. He Department
Environmerlta Hea d S i;trd Atths,tlMe of iilspectl- there appeared to ne a'septio r
system serving jAd site, If this system shouI unc#iort, the owner Is responsible for:
any necessai re�airs�
.,
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
of
AUTHORIZATION OF EXISTING SYSTEM
Health
Z
Date