ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE#_ft~e
ADDRESS 6~)/ f~4.3 i-f - ( Z013-3
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF Ow'NER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
PGRPOSE. OE INSPECTION; , T("~' "A' 1
Tfie aforementioned site has been evalue dy t~ie~Harne ountjl-Health Department - :
Y r ~T ,
-Environmental Healfh Section°``At ttietime of"inspection, there appeared to be a"septic
system serving thissite If this,system should malfundion,ahe owner is`respansir for
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
B~JIL ING MUST BE 5,' FROM ANY PARK' OF, SEPTIC SYSTEM
z D0-NOT DRIVE OR PARK(ON SEFTI~ SYSTEM
~s ✓ a 7 ` ~ CZ i ~d...£ _ . "'a'f4 ~ +i+~, ~ q. -k s ;4~ A'A~ . ? ~ c ~ o 2~ s° ~ ~ ~ k
AUTHORIZATION OF EXISTING SYSTEM
7-1
of Environ em al Health Specialist Date