ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS'T'ING SEP'T'IC SYSTEM INSPECTION
NAME PHONE # 9J-7 -?-;e:) ADDRESS ~ r~ ) t 7_- A,
NAME OF MOBILE HOME PARK OR S/D ?(t.4-L, cs
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE. OF INSPECTION: J1
The aforementioned site'has been evaluated byth %arneft'~aun tye5ffh Department f
Environmental Health Section. At the time of inspection, there appeared to be
system serving this site. If this system should malfunction, the owner is respo a septic
9 , risible 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_EE5 FROIWANY PART OF SEPTIC SYSTEM:-,,,'-,
DO_ NOT DRIVE 0 PARK ON SEPf IG SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date