ETHTE# QS- $ 22b576
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Pf-, jM PHONE # 91L-&1- //-5J(
?b' Bic , ra3 A Ja.v N. c .
ADDRESS z Q s~ - ~
IJC 7.74
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
T-
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated byte Harnett oun y e-a 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 V FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK OIL SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
4, fir- 3- S = 8-6
of Environmental Health Specialist Date