ETHTE# tc %,eq
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME �Jj,��p�QQ PHONE#
ADDRESS "C �-/o N r
,�w. fVC', 27,-�
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) Sc�•-�.P
ADDRESS OF OWNER (IFOIFFERENT) S
PROPERTY LOCATION: STATE ROAD NAME AND
PURPOSE OF INSPECTION: & e- K- 7A 3 to
The aforementioned site has been evaluated byte Harnett County—H-e-aftDepartment
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 A�
of EnvironmeniaYfIeatth Specialist Date