ETHTE# &,SW35 35-
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME &j4.,1 jg }%. PHONE #
ADDRESS II �\ i,� A(, ,err./
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT) 3! �6� A /U -
PROPERTY
�e
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated by the a—r—n—efFC—o`unfy1Te--a1th 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
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
of
AUTHORIZATION OF EXISTING SYSTEM
/'1 •k
Specialist
❑r
Date