ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
PHONE # 4~1-. (.qq
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # a~~ gECN~L
The aforementioned site has been evaluated by the Harnett County Health Environmental Health Section, tY Department
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
Bt11LDINE MUSS PE 5' FR01AF QEPT« SYSTEM NO, DRIVE OR P' ita1t 9E1~~'[~ SYSTE M
RIZATION OF EXISTING SYSTEM
Signature of Environmental
0C8
Date