ETHTE# - 26-7P8
HARNETT COUNTY HEALTH DEPARTMENT
EN`'IRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27545
EXISTING SEPTIC SYSTEM INSPECTION
NAME 'i /T~ PHONE # ` t ' /e~- ~Z3C
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # V11
PURPOSE OF INSPECTION- 30 fJ L) Zb - 1
The aforementioned site has been evaluated byte acne oun y ea fh 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 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF
z X/Ll~
of Environmental Health Specialist
STING SYSTEM
& -I.-tt
Date