ETHTE#-tt3 - SS--7
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME S S c ~ N I I r PHONE # 5/
ADDRESS
J /P/J/Yl r~t 1 & 4r-
NAME OF MOBILE HOME PARK OR S/D wv~ rYv~rS ~j C~ 0 , L
NAME OF OWNER (IF DIFFERENT) -f &L-"-
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ; t f
PURPOSE OF INSPECTION:
t
The aforementioned site has been evaluat y t e arne oun y ea -ft 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 II UST B 5' FROM ANY PART OF SEPTIC SYSTEM
D0 NOT DRIVE OR PARK ON SEPTIC SYSTEM
4UTHORIZATION OF EXISTING SYSTEM
Signature
L--~V)
Environmental Health Specialist
r(D Date