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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #"/`1 75
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ADDRESS J' !l.
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # i ~3
PURPOSE. O.E.INSPECTION Y f e"t, L ~w `may' n' 7
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The aforementioned site F~as.been evacuated by t me Z 61u j eatth Department'
Environmental- Health Section: At tl ~t e of inspection, there'appeared to be a septic
system serving.this site. If this system sh'outd `malfunction, the owner is responsible for
u : anv narpssar`v rPnairq,
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
" ;Lr 1} 1';Y. I 'r;K Tw.j%t ~ F..-TI ~~,;.-..ez*^4Y "a°!_ '4^S Y~;..~'-)P ~.:,:,i ~5 ~+7.4 Y? .:tiiS".. ~ •c. YS~ri u.~.. .~."t ,~A
BUILDING MUST. BE 5' FROM ANY PART OF. SEPTIC. SYSTEM
1 DO.zNO DRIV 01 PARK ON SEPTIC'SYSTEfW '
c,v t ,,r-: t~ S • ~d,£~ r~~,d ~ ,.ric _ ~y. a+.--a iy •~r`.`~ 2 , ``a'.~° Y ~'.-t=,: Y~.~'; ,yr ~,?r-~ 2 >'¢r' ''4~n~~ ` S" . _
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date