ETHTE# 0-
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME f An 0 /11 r L, v li PHONE #
ADDRESS 2 ~ ~ ~c'f drnc r CAhV,2o,.., /V C
NAME OF MOBILE HOME PARK OR S/DC f'f~~tsc~i~~ ~7
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ~(1k,2•r C~2~„z
PURPOSE OF INSPECTION;
The aforementioned site has been evaluat y 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 OIL PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature
(J~ -I3,v
Health Specialist
Date