ETH T E # z = 2,)'? PY
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME s ;a PHONE # 0~ ~
ADDRESS Fe), 3~1X y7 ~5 /3,I, A)bff,'-j c, Z-~ >L3
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) C/+y,1-61 + o C-e, 6
ADDRESS OF OWNER (IF DIFFERENT) 8V-, , l) S qz,/ ~ Z 2,35
-
PROPERTY LOCATION: STATE ROAD NAME AND # 1~tu q,7/
PURPOSE OF INSPECTION: . ~ru...,/! : ; _'~,a✓'?.- _
The aforementioned site has been evaluated by the arne oun y Heaffh Department
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
v _ 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 EE.5' F,F,OM ANY~PART OF SEP,TIO SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
-1 3-9 Z
ature of Environmental Health Specialist Date