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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME (i _ -►il--r~ .T;/}2 PHONE # ADDRESS 35zic 7. ~Z
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # i k c'3 " Pz,D
The aforementioned Site has been eva uated.by ff6
Environmentaf Health Section: At the time of inspect
system serving this site Ifithisaystem shouldmalfuni
anv~necessarvreDair<.
irneounV Y ea ~yDepartment
in, there'appeared to be aseptic
tion, the owner is responsible for:;
r t t y ti ~ -h
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
„bv
EUIl.aING MUST` BE 5' FROM ANY, PART OF. SEPfIG SYSTEM'.
Y
D0 NOT DRIVE OR PARK ON $EPTIG SYSTEMM
..t~_+1,u y".""`S°~n`xa•,.+7~ ~5 'h~._. it ~ r~~ ~
AUTHORIZATION OF EXISTING SYSTEM
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;Aature of Environmental Health Specialist Date