ETHTE# < 2 5- 2 3 4
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #
ADDRESS J04 NAME OF MOBILE HOME PARK OR SID (p4 Z
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #~l Yr s'J/~~
PURPOSE OF INSPECTION: _
The aforementioned site has been evaluat4 , t"arrre t oun y ea Department r
Environmental Health Section: At the time'of"inspection; there appeared to he a 'septic,-
sy stem serving this site. If this s stem.should m'
y alfunction, the owner is responsible for 3s
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 PARTOF.SEPTIC SYSTEM ~j
DO NOT DRIVE OR. PARK ON SEPTIG SYSTEM,
AUTHORIZATION OF EXISTING SYSTEM
_72-12-
re of Environmental Health Specialist Date