ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS'T'ING SEPTIC SYSTEM INSPECTION
NAME PHONE #
ADDRESS d'+ t-- P-", . C 2 Q';
NAME OF MOBILE HOME PARK OR S/D tDC
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 5?t 76 C- i 5'i%?
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The aforeirientioried site has been evaluated w:h- I~rne~ounfy~ea~fh Departm.<ent
En~vironmentaF Health Section: At the time "of inspection, there appeared to be aseptic, -
system serving this site.; If. this;system should `malfunction, the ownei` is resporisie for
t 4~~ ' :anV {~7â–ºecess pry_ re
CaP° ^ _F.,
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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 EE 5' FfOIN ANY-PARS` OF SEPTIC SYSTEM
Q NO DRIVE OIL PARK QN SEFTIG SYSTE
o~.~. ;5t rr 's...'n
AUTHORIZATION OF EXISTING SYSTEM
~Sigpature of Environmental Health Specialist Date