ETHTE# _2225-d
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #
ADDRESS~j±,o...
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) JA--r.,
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # PURPOSE OF INSPECTION:
The aforementioned site has been eva uat byte arse 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 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
O
Wjg~d
ature of Enviro t ;eL Specialist Date
-L/-4i