ET RHTE# 1.-=1 ~~01
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME _ p l f , j~i 5 PHONE #
ADDRESS 3
NAME OF MOBILE HOME PARK OR S/D ~,W-t 1-5 _
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 01 d CAS
PURPOSE OF INSPECTION: 5-11X 6)0 S YZ")
The aforementioned site has been evaluat by t e arne oun y 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 5! FROM ANY PART OF SEPTIC SYSTEM
00 NOT DRIVE OR .PARK 09 SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
:~r(Est, ..s. -
ature of Environmental Healt Spe 4alist Date