ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME & PHONE # `7
ADDRESS / i s C 1X13 a'-V -C..
NAME OF MOBILE HOME PARK OR S/D / r ~ C~
NAME OF OWNER (IFDIFFERENT) ` pore
ADDRESS OF OWNER (IF DIFFERENT) 16 fro vt C Ls- A/,
PROPERTY LOCATION: STATE ROAD NAME AND # PURPOSE OF INSPECTION:
av,
The aforementioned site has been ova uat y t h e arne oun ea Department
Environmental Health Section, At the time of Inspectlon there appeared to be aseptic
system serving thit site► if this Sy,,stem should malfunction the owner Is responsible for
any necessary repalr&
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' FRO ANY PA O SEPTIC SYSTEM
DO NOT DRIVE OR PARK O SEPTIC u%YSTE
AUTHORIZATION OF EXISTING SYSTEM
4
of Environmental Health Specialist
9 - 3 --1-2-
Date