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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME % 15 ~
- PHONE # 0 ` (a `I~ - Lt 76 7
ADDRESS! C, Z 75~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN-7) Jm J er ».I ~ ;
ADDRESS OF OWNER (IF DIFFERENT) - 5'3 *5&,v - ' f Fay r~ . Z 75? 1
PROPERTY LOCATION: STATE ROAD NAME AND #;5,1-_7 / y y
PURP.4SE:_OE INS'PECTION~ _ - . ~ r _ ~ .
The aforementioned,site f as "`den evaluated by re HarneM y ea Department' f
i'
Environmental- Health Suction' At the time of inspection, there appeared to be a septic I;
systemservingthis site Ifthis system's hould.malfunction; the owner is`responsible fore;
ti V
y rte- ;x~ 4 6 is any ~iecesaryrealrss r z~ #a
.y
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
.,T<'„C ~r.;f- rn. _ :..C:... - _t^
BUILDING MUST. BE 5' FROM_ANY PARS OF SEPTC`SYSTEM
DO NOT;DRl~lE OR PARK ON SEPTIG'VSTEN~ n
w _ .'E,,r=i~ .eF a4+. ~°s5~1 .+1 Gr".'f,b; .aU•,, `s-oK't)j y#i-n~^~A,•~¢ t,~~'~, r.,,_ ~f
AUTHORIZATION OF EXISTING SYSTEM
4" y/LLG
of Environmental Health Specialist Date