ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS'T'ING SEPTIC SYSTEM INSPECTION
NAME i4-,, `rs~a f = 5 PHONE # - sr 2z 75 ;-~i~
ADDRESS 4t)
NAME OF MOBILE HOME PARK OR S/D r~1 E~T
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 5~"t. t l r ~~r)
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,PURPOSE._OE,.INSPEC'TIONrt .,-:~-°~:f?•~.~''--<,. , ~ C~~
The aforementioned site has been evaluated by the Harneff oui~tyFfea~fh Department`
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Environmental- Health Section: At the time. of inspect on. there appeared to be a septic
f system serving.this site if this system should malfunction, the owner is;responsiole for ;
.ti!ytwY,°it
.
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
M BUILDING MUST, BE~ 5? FROM ANY PART OF, SERTIC SYSTEM
s F DO NAT; DRIVE OR PARK ON S`TIG ,SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
igioture of Environmental Health Specialist Date