ETHTE# S79
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # Q/S' G 31 ' W7�
ADDRESS //o b1AJA) Al_c
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 2jZ f/> // CL&&/?6
PURPOSE OF INSPECTION:
The aforementioned site has been eyal6ited by t e, Arne oun y ea Department
Environmental Health Section: At the time of inspection, thereappeared 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
of
AUTHORIZATION OF EXISTING SYSTEM
i7�irS y—�_i6
Date