ETHTE# 777
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME J DN7v Lam,
ADDRESS
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
NAME OF MOBILE HOME PARK OR S/D 6.4 Z
NAME OF OWNER (IF DIFFERENT) Qt,)jf } r) yytQ(r ,~ri
ADDRESS OF OWNER (IFDIFFERENT) 2~Cj 7?5-L&
PROPERTY LOCATION: STATE ROAD NAME AND # 5-YL/Y37 /31~ll,w-Q
PURPOSE OF INSPECTION: -b e w qw k'c `6 I
The aforementioned site has been evaluated byte me 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
AUTHORIZATION OF EXISTING SYSTEM
S
C_ Z7 T `[0
3, `Z'7 -l (
ture of Environmental Health Specialist
PHONE # q1 2-~ 7- P22
Date