ETHTE# C - 5-- 7a G 3 S
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME _LA4,,- 4.,-, o,,L J PHONE # ADDRESS ~S-`1Z9 - to i
?,b UA1=0
, _ K)-C, Z--7663
NAME OF MOBILE HOME PARK OR S/D &4-16- R -r. -4- / `7
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 5 2 14&E Lag-j6- P ' 7
PURPOSE OF INSPECTION.
The aforementioned site has been evaluated byte Harnett oun y ea Department
Environmental Health Section. At the time of inspection, there appeared to be s 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 V FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date
-O