ETHTE# 1 —7— g
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME �t D p tJfc <%O,LZ,tLS 0� i
ADDRESS b S S% v,2/�-.� � � /1 AVAIA
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PHONE # f10 U 27 - 5 50�
T, 33
PROPERTY LOCATION: STATE ROAD NAME AND #6 )% Z3 %y,� v4 -y.) /ZJ)
PURPOSE OF INSPECTION:
The aforementioned site has been evafuated by thearne oun y ea Department .i
Envfronmental Health Section: At the time of inspection,.,there; appeared to be a septic ,
system serving this`site. If this system should. malfunction, thiowner is responsible for
any necessary repalr&
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
Z -1 -
Date