ETHTE# ro-S - 7-5--32
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME _ /U6[5a,j g G• G • PHONE # -qgo - ~}6oZ
ADDRESS 70. gizc /951 A-) C Z'!Ttf (o
NAME OF MOBILE HOME PARK OR S/D /4-ta~ (414- Z
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT) A)-_C, 7-7S-CY
PROPERTY LOCATION: STATE ROAD NAME AND # 51LI'5-377- a 6,za„~ U~ t4o
neck.
PURPOSE OF INSPECTION: 4~ _ r s r-f yX N _ >3e S
The aforementioned site has been evaluated by the me 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 T FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
vim. llo&lfs
of Environmental Health Specialist
'D- I D
Date