ET RHTE# D9400- 1-13 7 2
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME R.-.x L36J Z PHONE # 3- rsa3-r
ADDRESS ~ c 6r.. - Lpk^ L L ~~n Aa^
NAME OF MOBILE HOME PARK OR S/D P)':> A-re r FAn nn1 Lo+
NAME OF OWNER (IF DIFFERENT) YA^-.e
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ~tC'C-0 03C 1`j
PURPOSE QFINSPECTION: la9- A c c
The aforementioned site has been evaluat t e arne oun 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
r
X BUILDING MUST B '5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR. PARK Oft SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signat a of Environmental Health Specialist Date