ETHTE# 1 07
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ti>nv.,lti~
PHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D -
NAME OF OWNER (IF DIFFERENT) (Xt-~
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # I &'-0, r-k
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared system serving this site. !f this system should malfunction, the owner i be septic
any necessary repairs. responsible for
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or
(2) the system should fait or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
BUILDING MUST BE Y FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM.
t
Signature
AU ORIZATION OF EXISTING SYSTEM
Environmental Health Specialist