ETHTE# 142 _ t/OOU &
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /n �, ��� J %Z PHONE #9/S 3S Zyg y
ADDRESS _Zttq 56&f'5 W ,Q LA � Ltm—X 7-7!5Z I
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ZPi 1675— /1)OL{dS U&4,4
PURPOSE OFINSPECTION I ZX 20 c5fU)�,6/6 W �1
The aforemenhonec sit his Been evatuate...y t e acne oun y ea,Li,rtrnent `
Envlronmenta Health'Section. At th, time of inspection, there appeared to be a septic
r
system servingt ris site, If this system should:malfunction, the owner is responsible for
x,g any necessary repairsri .,.
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 EEXXIS�EXISTINGSYSTEM
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of Environmental Health Specialist
/l'/7—
Date