ETH T E # O "1 )
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME R'R,,-OA F- PHONE # ADDRESS zC:1S _(0
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # C;-AQ,, 2-,~) S(211~°~
The aforementioned site has been evaluated by the Harnett County Health Department:
Environmental Health Section: At the tfine of iitspecttork there appeared to be a septW .41
system serving Old site. If this- system should' malt!n6t16rt, the owner Is responsible ford
any neeessar~ repairer
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
BUDDING MUSS' BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARIS ON SEPTIC SYSTEM
UTHORIZATION OF EXISTING SYSTEM
Signature of Environmental Health ecialist