ETHTE# ~ f'~ t=
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ffij lL. PHONE #
ADDRESS 53c~2- IU) 1)UN 1,3 t c - Z033 `l
NAME OF MOBILE HOME PARK OR S/D N e-5, 6V6C- -G~,~, 'S
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # PURPOSE OF INSPECTION. f3iu~ti C' rS ; ~,~1 ` F• ~j~.ry
The aforementioned site has been evaluated by t-h-e-H-ar-n-eff-Co-u-n-fy-ffe-a-fth Department;
Environmental Health Section. At the time of inspecti6n, 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
of Environmental Health Specialist
Date