ETHTE# 11
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME o 1ti PHONE # !5 /2 --e-41c,
ADDRESS
NAME OF MOBILE HOME PARK OR S/D ~!fig p
NAME OF OWNER (IF DIFFERENT) sc-
ADDRESS OF OWNER (IF DIFFERENT).
PROPERTY LOCATION: STATE ROAD NAME AND # ~Gtc.h~Thar aforementioned site has been evaluated by the Harnett dounty Health Department
Environmental Health Section At the time of Inspection, there appeared to be e septic
system serving this slta if thlj system should malfunctlon the owner Is responsible for
any necessary repalm
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 MUSS BE 5' FROM ANY PART OF SEPTIC SYSTEM
OQ NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUT
HORIZATION OF EXISTING SYSTEM
'7 ff
of Enviro el Health