ET RHTE#
NAME
PHONE # Wj - / 30;;L
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
The aforementioned site has been evaluated by the Harnett County Health Department;
Environmental Health Section, At the time of Inspectlon, there appeared to be a sews is
system serving this slts~ It this system should mahnctlon, the carnet Is responsible forj-
any necessary repalr
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
BUIl.QI1V{ MU 18E Y FROM ANY PART OF SEPTIC SYSTEM
DO NfDRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
14, 61 A 4 eS,
Signature of Environment Health Specialist Date
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION