ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
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NAME PHONE # 91q-,0,5-1-9-7X
ADDRESS 2 C , - ? &0 (0
NAME OF MOBILE HOME PARK OR S/D Uc~LL5 e1z
NAME OF OWNER (IFDIFFEREN7) `U Z fl- z
ADDRESS OF OWNER (IF DIFFERENT) 12-L 225b)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated by the Harnett can ea Department
Environmental Health Section,. At the time of Inspection, there appeared to be a septic
system servingthle situ If this system should malfunction the owner Is responsible for
any necessary repairer.
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 014 SEPTIC SYSTEM.
AUTHORIZATION OF EXISTING SYSTEM
S' `nature of Environmental Health Specialist Date