ETHTE# N- V J 4- k1 3~-3
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME S ~ 1 J VJA PHONE #
ADDRESS-22-2 L v OU n c
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) ~(t -c
PROPERTY LOCATION: STATE ROAD NAME AND # L P',- M
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section, At the time of inspection, there appeared to be a septic
system serving this site. If this system should, malfunction, the owner is responsible for l,
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 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
;natu a of Environmental Health Specialist Date