ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME c�(.IGZ �d �Sj'j�/TJ�CJN
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PHONE # p/D - fi?`j3 -637F
PROPERTY LOCATION: STATE ROAD NAME AND # 5&L51V dd�f aoe,6 /)
PURPOSE OF INSPECTION: l i u ut /3a//. Aa '
The aforementioned site has been evaluate byte HacneiffZ—q-5—My—TI-e—aft 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 necessaryrepairs.
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
AUU�T��HORIZATION OF EXISTING SYSTEM
Suture of Environmental Health Specialist Date