ET RHTE# be -S-- Zl5S12
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE ~ X35- gaj
ADDRESS ~Z~~ ~tJfl ,E'~J N Z75-OI
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT) Z8y6 O//> s• zij ~~,z; S r-. 0-7 --2
PROPERTY LOCATION: STATE ROAD NAME AND # r
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated byte Harnett Couffy-Tff-affh 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
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 BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
3- i-z -O
of Environmental Health Specialist
Date