ETHTE# O--)
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME C~-nOL-Z - ostoz•1E PHONE #
ADDRESS ~S ~~~~2RL>C~L '~P-) V NNS-v6-L- A(-- ~O
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #
The aforementioned site has l eers evaluated by the Harnett County He, altft Department
Environmental Health Section. At the time of [Ospkdbn, there appeared to be aseptic.
system. serving this site, If thli system should maifunctfoM the owner Is responsible for
any necessary repairs. 3
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 MUSS' BE 5' FRO1* ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
RIZATION OF EXISTING SYSTEM
Signature of Environmental Health