ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~6 lJ~~yn.,ll ~ 71~~c;ya ZaL PHONE #
ADDRESS VZYI ;(soU 2--2 3
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER IFDIFFERE~'
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ADDRESS OF OWNER (IFDIFFERE'VT) /15-2- t2✓/7 ~ .9b LA)~ /,).c- Zs j~'y
PROPERTY LOCATION: STATE ROAD NAME AND # J~~- /?'76,, Cpl l) f t`
PURPOSE. OF INSPECTION, - ~~dl : F C -,o L
The aforementioned site has been evaluated by the, Harnett oun y Health 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
re of Environmental Health Spe
list
Date
i/