ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 0 6-) Z b 10
ADDRESS Z00 l Lu L~ b `5 i
NAME OF MOBILE HOME PARK OR S/D S
NAME OF OWNER (IFDIFFERENT) C U ~V ~ l ~°r
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND
PURPOSE OF INSPECTION:n
Th'e aforementioned site has been 0aluated by t-he~-larne oun~y I~eaTfh Department f
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'SEPTIG SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
z
of Environmental Health Specialist
Date
t