ET RHTE# 09 - ZZZ
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
PHONE # 91 g-ss z -6; 33
ADDRESS 14
z-zsz.
NAME OF MOBILE HOME PARK OR S/D -L-)45
!3vt3 ,,r,,,~ N 5 ~ see
NAME OF OWNER (IFDIFFERENT) _
ADDRESS OF OWNER (IFDIFFERENT) yes g
PROPERTY LOCATION: STATE ROAD NAME AND # S k lglz
PURPOSE OF INSPECTWN cf fit, s ,mod s„~ mow,
The aforementioned site has been evaluated by t! I e arne oun ea 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
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date