ET RHTE# ~ - l j-1 2'r'L
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAMES PHONE #
A 5 7 -
ADDRESS ~i ~f " C1:' d 5r ze b z Yt l P C:-: Z ? S
NAME OF MOBILE HOME PARK OR S/D p p d a
NAME OF OWNER (IFDIFFERENT) /Z•: ~s~
ADDRESS OF OWNER (IF DIFFERENT) 7 LJ z_ Kgn;r
PROPERTY LOCATION: STATE ROAD NAME AND
The aforementioned site h"as been eialuated by e Irneoun yl~eaffh Department ;f
Environmental-Health Section; At the,time of inspecti on, there appeared to be a septic
of a K`Y, 1 q F+
system serving,this ite,:lf this;s'Mem sh`ould:malfunction, the owner Is:responsible for
anci rioircccani ranairc ",r!
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
.,x ~ca: ~ ,%J a,'r '-c„-rti ~ a q6.~ t ~,,.v: ♦ c- a;y:. :.jr
BUILDING MUST BE 5! FROM ANY PART 0E SEPTIC SVST,EIVI :
Q0NOT, DRIVE OR PARK ON_,SEPTIG, SYSTEM - y
AUTHORIZATION OF EXISTING SYSTEM
7 -~l
ture of Environmental Health Specialist Date
A3 . c
Z7S=j -Z-