ETHTE# 01 DO-
NAME
ADDRESS
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
PHONE #
.~j N---
NAME OF MOBILE HOME PARK OR S/D D L. f r~
NAME OF OWNER (IF DIFFERENT) S(f'~
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # oR:)
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated by t e arne oun y ea Department
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
A THORIZATION OF EXISTING SYSTEM
2-D~{J~
Signatur of Environmental Health Specialist Date