ETHTE# % -5 -26
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # Y%O
ADDRESS ld.?c~Qr~ J /1-1 C': V
NAME OF MOBILE HOME PART{ OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFEREV_1) b2 ~ ~ 14) J)yiJ'ry fi C _ Z ;J-X/
PROPERTY LOCATION: STATE ROAD NAME AND # PURPOSE OFINSPECTIOAr
The aforementioned site has been evaluated byte 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
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 DUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DG NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Si ature of Environmen
-fq
Date
Health Specialist