ETHTE# 8 L
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE# -N 6Z-c- IZ7-4,
ADDRESS t2z-0 bh"" (J'S . 29331
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFEREN-7) e7_5~. 005eJb , r" 2 g;? 31
PROPERTY LOCATION: STATE ROAD NAME AND # ' 17 e9 WOS i- t3t, r~Z
PURPOSE. OE INSPECTION; t f/ -it'. a ,.<< • , '7
The aforementioned site ,as b eery evaluated yt a arneoun y ea Department
Environmental Health Section: At,the;time of inspection, there appeared to be a:s,eptic _ 4
system servin94 is site If this,system should malfunction,-the owneG fs responsible for
t ~r any necessary,repairs t ~ i3
az1 _ - _ ' '4
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 PARS GF. SEPTIC SYSTEM _
DG NOT DRIVE OR PARK.OWSEPTIG'SYSTEM.,
AUTHORIZATION OF EXISTING SYSTEM
A
re of Environmental Health Specialist Date