ETHTE# Q _ s= %V,2-73
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME r+°'I %jr Ly PHONE # ADDRESS l 1
NAME OF MOBILE HOME PARK OR SID
NAME OF OWNER (IF DIFFEREN7) _
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
h: rte.
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Sodom. At the time of lnspecticr4 there appeared to be a aseptic
system serving this site. N this system should malfuncdom, the owner is responsible for V
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 O"P SEPTIC S1tSTEi~
0 NOT DRIVE OR PARK ON SEPTIC SYSTEM
THORIZATTION OF EXISTING SYSTEM
ature of Environmental ealth Specialist Date