ETHTE# 0 1- 5- / (?0
t) '7-16-- /q0
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 47 0- Wt d t4' ~5 r I t S PHONE #
9- S
ADDRESS DYl 3cli ?j I e.~~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
~t
PROPERTY LOCATION: STATE ROAD NAME AND # 3''5M.3 f ra!
The aforementioned site has been evaluated by the Harnett County Health Department F,
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 S' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of En
le' s
Specialist
,-2113
Date