ETHTE# & -S- 25551
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME c~C . PHONE # 9/9-868 *903
ADDRESS dy3Z leV A)-e- 170=(,e!!
NAME OF MOBILE HOME PART{ OR S/D A5Aj- S Cg,- 7
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT) /b y
PROPERTY LOCATION: STATE ROAD NAME AND # 147,x} y 9Z
PURPOSE OF INSPECTION: qbb ~5_ -ST C
The aforementioned site has been evaluated by t e arnett Coun
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
re of Environmental Health Specialist
-/Z-/o
Date