ETHTE# 617-5'- 2/77.3
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
0
NAME n'laia,~.s PHONE # IFI-) - ~3S!
ADDRESS 93
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 52 ig-72 dR-K _ Gig ~p
PURPOSE OF INSPECTION
The aforementioned site has been evaluate byte 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 Y FROM ANY PART OF SEPTIC SYSTEM
DES NOT DRIVE OR PARK ON SEPTIC. SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date
S