ETHTE# "^7/ qq
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Q n
PHONE # L rj ~a - "73~j
ADDRESS
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NAME OF MOBILE HOME PARK OR S/D
NANIE OF OWNER (IF DIFFERENT) -Du- l r M-ere - t U)
ADDRESS OF OWNER (IF DIFFERENT) (o 0 D Wa j- L4 - Ljc~tn
PROPERTY LOCATION: STATE ROAD NAME AND # Vlra h d4 L~an c
PURPOSE OF INSPECTION: J d t T i U n
The aforementioned site has been evaluated by the arnettoun y ea
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
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Department
r J► - b 1Z
Sig ture of Environmental Health Specialist Date