ETHTE# 1&-53g731P
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 43IA�<4� Cyl PHONE # 915 -"l —,q010
1
ADDRESS Z61 N.C,
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT).�t-�,�� /,Jere>T
ADDRESS OF OWNER (IF DIFFERENT) /�jD s�iSJsc,4L,slcO UJ %�PJ���. C
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PROPERTY LOCATION: STATE ROAD NAME AND # / k
PURPOSE OF INSPECTION
The aforementioned site has been evaluate, by; the
the aun y 05ifit Department
Environmental 14ea' n. At Kh Sectiotiis,time of, inspection, there`appeared to be a septan 5
system serving this site,' If this Sys ern shouldrnalfuii ion, the owneris responsible for
any necessary repairte j -1s
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
�a s 3a 16
of Environmental Health Specialist Date