ETHTE# JJ2 - _ ~ 4
NAME
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
ADDRESS d~NAME OF MOBILE HOME PARK OR S/D
PHONE # NAME OF OWNER (IFDIFFERENT) e r'Y(I va fi S
ADDRESS OF OWNER (IF DIFFERENT) 5? 15- L) L; ~'C~l1J4e'r
PROPERTY LOCATION: STATE ROAD NAME AND # H U 3c) 1_
PURPOSE OF INSPECTION: S ISM H W/o Prv?4-'r )xe m1a'S
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 Sy FROM ANY PARTOP SEPTIC SYSTEM
00 NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of
Specialist
'57//~q//a
Date
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