ET- See Repair File for (Shirley McKoy IPAC only)HTE#~ Z ZL~
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS'T'ING SEPTIC SYSTEM INSPEC'T'ION
NAME .`T~SaJ-5c~v PHONE#
ADDRESS 1'1''~ ~ c ~CSIe - (_U~ c , 73 je7
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT ~L'o ~G je / v & C
PROPERTY LOCATION: STATE ROAD NAME AND # if,) /
PURPOSE, OF INSPECTION:
.The aforementioned site has been evaluated byte arneoun-I 6- lth Department
Environmental Health, Section; At the time of inspection, there appeared to be a`septiG
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 EE.5t FRONT ANY'PART`OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON 'SEPTIC SYSTEW . ~
AUTHORIZATION OF
of Environmental Health Specialist
FISTING SYSTEM
Date