ET RHTE #: )'�'3,1R-
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: 5 �AN�c-- sPhone #: `1,� "i'A -7631
Address: 6� cf (Lf ma?o-,3 k3G `a&
Name of Mobile Home Park or S /D: ftz >5 cwt Lc,-r
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): \15`7 qc,,, a�-
Purpose of Inspection: MoE) L, er- ('O'
tz�gl L� aP� -4
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 the system should malfunction, the owner is responsible for 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 change, and/or
4. after six months
C / KRIM
AUTHORIZATION OF EXISTING SYSTEM
E
Signature of Environmental He t Speciali