ETH T E # 7 fly
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEP'T'IC SYSTEM INSPECTION
NAME _ r vk l .-J G" fti ,v PHONE # G 5,2 - G 3J(
ADDRESS 7 l7 I I J1-~ / C c ! 37
NAME OF MOBILE HOME PARK OR S/D r Lr t S r 1) NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ',>5~- _2e)'3) PURPOSE OE INSPECTION:,
The aforementioned.site "as been evaluated-by ^tFi-e ffirne o n y ea Departmbht
Environmental. Health Section, At the ime,of inspection, there'appeared to be aseptic',-J
system serving,this site Ifthis system should.Ma'lfunctfoh the owner is responsible for
m , 4 5 anycesary repairs:°x t%
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
~ f+d ~ r-: ~ r'~,-s• ~m.;.~ tx lm 1 ~ ...F4i ti..~ _ ~ n w. _..r
BUILDING DUST. BE 5' FROM ANY PART OF SEPTIC SYSTEM
f
X DO NO T DRIVE OR-PARK OIL SEPTIG SYSTEM
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.;aett.. es ~*m• _
AUTHORIZATION ✓OF EXISTING SYSTEM
of Environmental Health Specialist Date