ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME -70"r4-Y 9-C woes
PHONE # ab3-a,`1'CU
ADDRESS G1-"D L- c ~1oT $Q,. p~E QZ Lt wOE.' C a`33~J~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IFDIFFERENZ)
PROPERTY LOCATION: STATE ROAD NAME AND #
The aforementioned site has been evaluated by the Harnett County Health Dement
Environmental Health Sections At the time of in% ctloi% there appeared to bo a septic
system serving thi# site. K this rMem should malfunctloM the ownor Is responsible for
any necessary repair,.
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 5' FROM ANY PART OF SEPTIC SYSTEM
00 NOT DRIVE OR PARK Obi SEPTIC SYSTEM '
tIZATION OF EXISTING SYSTEM
0
Signature of Environmental