ETHTE# 08 -5 --Ze7-78
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 9!U - 9151 -Z65
ADDRESS . 3 ZZ !/S YD/AJ Lrllr,.~y /y C . Z 7 S" y~
NAME OF MOBILE HOME PARK OR S/D CU y~4)~zy 6/- 'j ~p f
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # G<Jy ye)llt/
PURPOSE OF INSPECTION:
The aforementioned site has been eval ated byte Harnett oun y ea 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
DES NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
5= /Z
of Environmental Health Specialist Date