ETHTE# p --J~r3G6
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # sIttZ- Qz9 3
ADDRESS 5 Gk sf,, Gr' l~l~ S N C 2 7X'y d
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # _ z
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspec#I'on there appeared to be a septic.
system serving thld site. if this system should malfunctloM the owner Is responsible fore
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 "FROM ANY PART OF SEPTIC SYSTEM
00 NOT DRIVE OR PARIS OIL SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
1-1/_
Date