ETHTE# Cn-5-19 C)
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE# 5,) 1-mac1-I
ADDRESS Z~,63 ~~cni~,~LS VQ.~ S~,cLNNc Lam ~G ~ ~4
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # Rc,
Theaforementioned site has been evaluated by tote Harnett County Health Department
Environmental Health Section Ax thu timof Inspecdorr there appeared to b** septla
system serving thtt sit#. N thi t system should ma lndlorr, the owner Is responsible fori,
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 T FROM ANY PART OF SEPTIC SYSTEM!
00 NOT DRIVE OR PARK ON SEPTIC SYSTEM
THORIZATION OF EXISTING SYSTEM
2S b8
Signature of Environmental Health S&q(alist Date