ETHTE# 1-7-5-- - qo%ZZ-
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAMEJ �/�% ���� PHONE # 5'79- 7.57-5837
ADDRESS G/5 lNc, idi 2JCLv L Aa N. C .
NAME OF MOBILE HOME PARK OR S/D 7
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) 2-4 '5- 1�7N� � Q bX ,gw� N G -Z7SW
PROPERTY LOCATION: STATE ROAD NAME AND # d;,/o0 & o o
PURPOSE OF INSPECTION:
The aforementioned site has been evalu 1 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 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date