ETHTE# - 2 ~4
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME s w PHONE # ji 2- 79- / 2. ,
ADDRESS qja Z-x" f
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) /
ADDRESS OF OWNER (IFDIFFERENT) 12J& 1JA-
PROPERTY LOCATION: STATE ROAD NAME AND # . ,
PURPOSE O,F INSPECTION: -
The aforementioned site has been eve uat , y t " erne oun ea Department
Environmental Health Sectlort fit the time of Inspectiorrj there appeared to be aseptic
system serving this situ If this syAtem should malfunction the owner Is responsible for
any necessary repalre F
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 DUST E 5FROM ANY PART O SEPTIC SYSTEM
D NOT DRIVE OR PARK ON SEPTIC SYSTEM.
of Environmental Health Specialist
AUTHORIZATION OF EXISTING SYSTEM