ETHTE# .41/ - 1 ~ 2 L
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
J
NAME /L ~ /7 -
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
PHONE # P ' - ' !'vtJ
NAME OF OWNER (IF DIFFERENT)'f~r~ia~~
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #'~r;
PU"OSE. OF, INSPECTIONry i, ~%5 ; ,V, :X -
The aforementioned.site l"' s been eiialua ae gyp a Wal-rne oun y ea *Department
Environmental Health Section: At the time:of inspection; there appteared to be aseptic,
system serving this;sitd- if this,system should.malfunction,,the owner is responsible fo+r
ny,neces~ry.fepj al`s. :F 5.•^'at~t C'v fi: ka #~a,,,,{
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
,h..:~cu';, iw ,e '.,wirc orir"rs •:rcYk~ `e; ° G~~. - :+i;i. f',.~d F~*. ~ ;:x i - _vn,:. -v „i~fa
BUILDING MUST. BE 57 FROM ANY: PART OF, SEPTIC SYSTEM
DO NOT DRIVE-011, PARK GN SEPTIC SYSTEM .F
y l,:r. ~ i~p'~>'~`,'f , ,~,"''ti`~;~ r yrF ."~,,:ir,~..~a+~71:ia31+; Y"7' k;Y_ 7' 5f`{, r'~71 ~:,rr•~ i o v.3'.4 :~r'$ i`f.~ ~
AUTHORIZATION OF EXISTING SYSTEM
~t~ureI /
- 11 f Environmental Health Specialist Date