ETHTE# -5-3%06Y
HARNETT COUNTY HEALTH DEPARTMENT
ENV]RONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ;L)iiaJ�/ / 5;11 PHONE # %! a1 —�O —7,a
ADDRESS 56�,--2
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
V_
PROPERTY LOCATION: STATE ROAD NAME AND # 5-c /Y<)3 a
1�--4-6
PURPOSE OF INSPECTION: 3
The aforementioned site has been e , valuated bytearne oun y 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
, 5:z J �g � 9-v- !
of Environmental Health Specialist Date