ETHTE# G- 06L 9/3b
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Cj�tro l y rg e
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) 56r- 4&�
PHONE # q/0
ADDRESS OF OWNER (IF DIFFERENT) 5,;L P$-. nn //
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE OF INSPECTION: PC1d�L%.
The aforementioned site has been ova uated y e arne oun y ea th 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
5 -
of
of Enviroitnw6tal Health Specialist Date