ETHTE# j~s= y
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # ADDRESS 12 8 ff Xwy 76 C 'Z'71;-Z'3
NAME OF MOBILE HOME PARK OR S/D tills / Cn A~;j~
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # -IiW /A3/ LdAg,( /4,
The aforementioned site has been evaluated by the Harnett County Health 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 T FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
G7
of Environmental Health Specialist Date
Y