ETHTE# 2Z
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Y/ "Z ltd E' rG AT'P' PHONE # ` 1 - 4t'Z 7 - ' 2'i l
ADDRESS ~-7~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #,5i /5 yq i /~6
PURPOSE OF INSPECTION: -5Z k L10 ,S - i7~-f- r'l Lt ,c ~ P
The aforementioned site has been evaluated th-e-Ra-r-n-elFC-o-u-nFy-He--affh 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 DUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
_P_i
Date
ature of Environmental Health Specialist