ETHTE# &"5 - 192ZI
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME L//A 11~4 4-- PHONE ~~7
ADDRESS ~y ~iZ~-rte -oVizF )a"" if
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #.5W 1%03 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, 0 Y FROM ANY f?At~ OF SEPTIC SYSTEM
DON-; DME OR PARK 01 3 T[C $YSTEM
AUTHORIZATION OF EXISTING SYSTEM
• L I 2-s of Environmental ealth Specialist Date