ETHTE# C3-1 -S 1~11a
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PosSCL~ c.,~ Cp.,tQ~o N PHONE #
ADDRESS V-7 li~u vcy-w-o LP,,-s-- Q-9 S A ~ ~q~ .D ~.1 C, 133
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # "w 1
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At th* time of Inspectlom there appeared to be a septic •
system serving this site. if this system should malfunction, the owner is responsible fort
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 DUST QE 5` FROM ANY PARS' of SEPTIC, SYSTEM
DO NOT DRIVE OR PARK CAN SEPTIC SYSTEM
I
THORIZATION OF EXISTING SYSTEM
11
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'4N, I ~ 6X
Signature of Environmental Health gbecialist r.