ETHTE# /h - s- ac�7
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME &hA V.X1 � ��5 PHONE # 7/- j%- 7.2 32-
ADDRESS
Z
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) ';i `-
ADDRESS OF OWNER (IF DIFFERENT) 5
- V ek �
PROPERTY LOCATION: STATE ROAD NAME AND # tQ p
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated byte llarne 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
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environiff6ntal Health Specialist I Date