ETHTE# 0-~
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
NAME
ADDRESS
PHONE # ( Iq 'K5 -q'700
NAME OF MOBILE HOME PARK OR S/D di&t `tyyy,~• f
NAME OF OWNER (IF DIFFERENT) (fin
ADDRESS OF OWNER (IF DIFFERENT) &13
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE OF INSPECTION ex,
The aforementioned site has been eva uat Y t e acne 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
BUILDING MUST BE Y FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmen 1 H lth Specialist Date
EXISTING SEPTIC SYSTEM INSPECTION