ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # `l C` 5/1/- 35b 8
ADDRESS 5(V 7 m m o.5 Rd, btwn, Nb a9339
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE OF INSPECTION: A 5 x 3 Cp Ve re-J -Pa`A~o
The aforementioned site has been evaluated by the arne t oun y ea 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
,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 T FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC. SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
a'm &
Signature of
4 Specialist
q-2-1-10
Date