ETHTE# I0`Ste--4393~
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ZFl Ck
ADDRESS I ~ (3 1 A
M
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NAME OF MOBILE HOME PARK OR S/D LJ, L-f ~ Ac-
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) A
PROPERTY LOCATION: STATE ROAD NAME AND # 1 Z 2'2-
i
PURPOSE OF INSPECTION:
The aforementioned site has been evaluate byte Harnett 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 5F PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK OR SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of
w v-A- ~EHS
Specialist
PHONE # d333 t
I- I'D
Date