ETHTE# -a-- f ~ I
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
` EXISTING SEPTIC SYSTEM INSPECTION
NAME 7 V-C-r4 PHONE #
ADDRESS L
NAME OF MOBILE HOME PARK OR S/D [je) W 2J
NAME OF OWNER (IFDIFFEREN7) - LQc~~
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #
The aforementioned sits has been evaluated by the Hamett County Hoalth Department
Environmental Health 5ecdon At the time of Inspe dor% there Appeared to be a septic :
system serving thlai situ if this system should malfunctiM the owner Is responsible fori
any necessa4 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
BUILOING MUST BE S' FROM ANY PART OF SEPTIC SYSTEW
DO NOT DRIVE OR PARR OIL SEPTIC SYSTEM(.
AUTHORIZATION OF EXISTING SYSTEM
A
S
Environmental Health Specialist
Date