ETHTE# 17— 91LtW)S
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Qrv/� ¢ rT. ��^/ l�¢�— PHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D/
NAME OF OWNER (IFDIFFERENT) S
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # fly:0&
I
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated by th—e-I4ar—ne—fft—ou—nTy-He—a—Ith 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
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AUTHORIZATION
/OFF EXISTING SYSTEM j
of Environnkfital Health Specialist Date