ETHTE# -5 ° Z-7110
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~7Q z A-2-4 /7 r PHONE # 7 , ~ - U (
ADDRESS t~v r /60 el y 3 '7 'r
NAME OF MOBILE HOME PARK OR S/D ~~,j, s,s (A-4 1 /&6
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #~r~~7
r
PURPOSE OF INSPECTION; p _ , , .
The aforementioned site has been evaluated bytFe Harnet~~oun y eaTfh 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 fora;
any necessary repairs:
E
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 BEV5' FROMANY'PARTOF.SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM.
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date