ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS'T'ING SEPTIC SYSTEM INSPECTION
NAME ~z'c'j (:t,(~,> PHONE#'-6-
ADDRESS
'2-2-P LAVLc_ ML
NAME OF MOBILE HOME PARK OR S/D I kea by ✓ L'
r
NAME OF OWNER (IFDIFFERENT) ADDRESS OF OWNER (IF DIFFEREN7) J")i~'L~ ( j/' (rIS;.
PROPERTY LOCATION: STATE ROAD NAME AND # 8A
PURPOSE. OF INSPEC
The aforementioned site has been evaluated~y theme- arnettoun y ea ffb Department
Environmental Health. Section. At the time of inspection, there appeared to be a septic s
system seining 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 BUST BE 5' FRWANA PART OF, SEPTIC SYSTEM
-DO t~OT DRIVE OR PARK ON'SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
"gnafure of Environmental Health Specialist Date
`i'