ETf 1-~
HTE#(
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME el ~ PHONE # 9/ cl -5-j '-7iw-
ADDRESS 13 0--/- 0 a-7':~ C. Z-03-35-
NAME OF MOBILE HOME PARK OR S/D ~5u ! € L-~-7
NAME OF OWNER (IF DIFFERENT) i lc?l
ADDRESS OF OWNER (IF DIFFERENT) : 2~
PROPERTY LOCATION: STATE ROAD NAME AND # 7 /
#z 13/
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated t e arne 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
DG NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
/~J' ~0'-zo - /I
S
ure of Environmental'Health Specialist
Date