ETHTE# 0cr-t -ZZ(Vq
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Z4) o~d~ ~YI PHONE # 4/-030/
ADDRESS j
NAME OF MOBILE HOME PARK OR S/D-7~ ~(o ltrJS /3
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # `-/L. /-7 0
PURPOSE OF INSPECTION: L'0
The aforementioned site has been evaloa y 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
BUILDING MUST BE Y FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Sig#ture of Environmenfal Health Specialist
Date