ETHTE# lb -5-- ~ 5-33(o
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~ 4mP( ~CU~ w~ ~L(J a~nH~ PHONE # 7ld C~7
ADDRESS (p J U
NAME OF MOBILE HOME PARK OR S/D
.303
NAME OF OWNER (IFDIFFERENT) I/ t
ADDRESS OF OWNER (IF DIFFERENT) ~ 10 l U (214 ( l/
PROPERTY LOCATION: STATE ROAD NAME AND # ~lo T
PURPOSE OF INSPECTION:
The aforementioned site has been evaluat y t e arne oun 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 repairsf
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
0
Signature of Environmental ealth Snecia iat r _
v
s
Owner 1 "
IN)
(MAILING ADDRESS)
Location of Premises (MAILING ADDRESS)
(SUBDIVISION. STREET OR ROAD NAME oft NUMBER. LOT NO.)
Details of Septic Tank System
Kind of Material
for Tank: E Concrete ❑ Other
Size of /Qo
Tank: Capacity 0 Gallons
Subsurface No. of Exact Length Width of Depth of it-;_v
Drainage Field Ditches of each Ditch z Ft. Ditches _ Ft Ditches Inches
Square Feet In Absorption Field Surface Drainage Linear
Required Ft.
Inspected by - 42-4 /41- h iq ~ ( AN1T )
Permit No.- Cl' U Date
Aff s
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