ET RRHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME n A N\c,, ~I - PHONE # ~M- 7 2 Y-1
ADDRESS 31a a~ C~~. en ~1 C
C,~_ L,4
NAME OF MOBILE HOME PARK OR S/D j~,,
NAME OF OWNER (IF DIFFERENT) E4 t \p ~
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 5 1
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated y the 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
Bul.WING MUST B 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK O.N SEPTIC SYSTEM j`
AUTHORIZATION OF EXISTING SYSTEM
Signa a of Environmental Health Specialist Date