ETHTE# CA s-1~ 3
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME -:5p% fsn r~ E L--\,3
PHONE # `3 4-`1,`k-1
ADDRESS 3-,`1`14 ~cx,S ~-D e t1 c, c N
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # Q-9 W
The aforementioned site has been evaluated by the Harnett County Health Department ~4'
Environmental Health Section At the time of ipspectlok there appeared to be a septic.
system serving this site. If this system should malfunctiorv, the owner Is responsible for' f
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 P. OF SEPTI. SYSTEM
DO NOT DRIVE OR PARK ,O SEPTIO SYSTEM
;~UORIZATION OF EXISTING SYSTEM
Signature of Environmental Health
4 Llo