ETHTE# - 7
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME % CJS r~ Z~ ce- PHONE # ADDRESS Aj -75
NAME OF MOBILE HOME PARK OR S/D 00 C C6 S
NAME OF OWNER (IFDIFFERE.~r7)%c~~ YE r
ADDRESS OF OWNER (IFDIFFERENT) It f , V, C 77576,
PROPERTY LOCATION: STATE ROAD NAME AND # 1~°3-7 PIA
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated ty a-Marne oun y H 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 EXISTING SYSTEM
of Environmental Health Specialist
Date