ETHTE# OV~S-1545
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ?C)(Z aL. t-~N R2fl PHONE #
`1~1~-6SS J
ADDRESS 133. t2-P,,j 9--D f .gz).4c.
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #
The aforementioned site has been evaluated by the Harnett County Health Department s.
Environmental Health Section, At the time of Inspection, there appeared to be a septle
system serving this site. If this system should malfunctlorr, the owner Is responsible for
any necessary repalrs.
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
Signature of
Specialist
317