ETHTE# 6~- -5-- ZjF0 -t
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Z, PHONE # f- S75-2 - 7335-
r]
ADDRESS ' ~ q O ej~ F. V C. 2
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ~ NOY
PURPOSE OF INSPECTION: - o
The aforementioned site has been evalu-a-te-d byte arne Couhtyife-a-fth 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 responsibly 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,
DO NOT DRIVE OR PARK OIL SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
S
of Environmental Health Specialist
Date