ETHTE# 1}05 G
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME_ ~~~~/fry -f- (5 A1yj,► o Sna.,~ PHONE # 7- y :r 4t42
ADDRESS 5-7D C/lfy,(~.2._/L~ ,E7y,•s,v nl C B3 3'Y
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 2007
The afoementtonecf"sit~i hes. Well evaluated the Hamett County Healt4 Department
Envtronmentat Heaitt~ 5ectta►n. At e
time of tnspect~oo~ there appear od to t* a sepfG ;
system servfh tflts site. Ift'-h ! s
g y►sfem should rriAWctt ' k- the owner is risp"onsibte fog
any necessary revair
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
neann apeciansc
J
Date
AUTHORIZATION OF EXISTING SYSTEM