ETHTE# f0 -5-- Z5~ZZ
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ('74h e-5 PHONE # 9/9-772
_ Soli
ADDRESS 3912. NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)1~1cc~2P
ADDRESS OF OWNER (IFDIFFERENI) 3(Z5- 833q
PROPERTY LOCATION: STATE ROAD NAME AND # ~1Z 1 Z
PURPOSE OF INSPECTION: ti
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The aforementioned site has been ev luated by the arne 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
DO NOT DRIVE OR PART( ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
ature of Environmental HealthrmSpe cialist
/6 - Z8 /0
Date