ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Bl>Pinr%��A PHONE#</D-SS2-93y
ADDRESS
NAME OF MOBILE HOME PARK OR S/D,�
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT) aS�3 �Gt �vs�)M-
PROPERTY LOCATION: STATE ROAD NAME AND
PURPOSE OF INSPECTION:
The aforementioned site has been evaluat-ed--b-Y-the-Ra-r-n-effZ-O-u-nfy-H-ea-M 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
s AUTHORIZATION OF EXISTING SYSTEM
xf —I -(I- d /
Sign re of Environmenta Health Specialist Date