ETHTE# -77t 5
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME o'r PHONE #l
ADDRESS ~°7' %'}?u Lea C 1~~.~ C' Itz-!.~-t
NAME OF MOBILE HOME PARK OR S/D /j, Ilee
NAME OF OWNER (IFDIFFERENTI
ADDRESS OF OWNER (IF DIFFERENT) j 7 1 l /fy,,,~
PROPERTY LOCATION: STA'L'E ROAD NAME AND # ~ ?0?e j
PURPOSE. OE.INSPEC7'10~1r; 3~} ~ ~ . ~ ~:z~'~'~--
Theaforementioned site has been evaluated bytTie Rarneoun~y~fea~fFi Department` 3
Environmental' Healfh Section: At the time of inspection, there appeared to_ be a;septiay-"
system seN[h ' this site If this system should malfunction, the owner ls'responsible fore;
~any riecessary.repairs
3 r" t a
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
4 ,
BUIWING MUST EE.5' FRORANY PARS OF SEPTIC SYSTEN9
DO NOT DRIVE OR PARK ON,SEPTIC,:SYSTEM, j
AUTHORIZATION OF EXISTING SYSTEM
ature of Environmental Health Specialist Date