ETHTE# 16 - S--- 251q /
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # -
ADDRESS r y ge k- -r~-n J ~,4„
Z~ 03
NAME OF MOBILE HOME PARK OR SAD
NAME OF OWNER (IFDIFFERENT) _ DO,) «E'
ADDRESS OF OWNER (IFDIFFERENT) 0 , t3,-)v Z2Z7
IEJ C, Z 8303
PROPERTY LOCATION: STATE ROAD NAME AND # ~-)S 120
PURPOSE OF INSPECTION: I'0 2 /J 0
The aforementioned site has been evaluat e '4- ~e.cv~G
Y arne 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
of Environmental Health Specialist
Date