ET--77 Z-7 &
HTE# - W2HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
ADDRESS
'16
NAME OF MOBILE HOME PARK OR S/D
PHONE # Z5-2 - S-7t~-.-F€ L~
. Z O:3 <
NAME OF OWNER (IFDIFFEREV7) Yt ~ ~ ~ J{
ADDRESS OF OWNER (IFDIFFERENT)G
PROPERTY LOCATION: STATE ROAD NAME AND # 11 O'E",d J f Q5
PURPOSE OF.INSPECTION- -42 i n
The aforementioned site has been evaluated by tFie Rarneoun y eaTfh Department e;
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
an necessa re airs:
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 0F; SEPTIC SYSTEM
DO_ NOT QRIYE OR PARK ON SYSTEM
SEPTA
- -
AUTHORIZATION OF EXISTING SYSTEM
re of Environmental Health Specialist
cc-
Date