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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #c10, ,)7 -13~)
ADDRESS 2j'-5 kW~ I Ct- i
NAME OF MOBILE HOME PARK OR MD iG1 L LI(
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ~ e 7 0 1,~~
PURPOSE. OFINSPECTION: En 4) j _ 5jt~ ~~T_ « D t~ ^
The aforementioned site_ has been evaluated by the Aarne oun y,HeaTth Department
, . -
Environmental Health Section: At the time of inspection, there, . i { appeared to be a septic
system serving,this 'site: If this,system should.inalfunction, the owiner, fs`resN.ponsibla for Kp
anyecessary 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 MUST BE 5' FROM ANY FART OF SEPTIC SYSTEM
r
X r 4 DO NOT DRIVE. OR PARK OWSEPTIC, SYSTEM R
AUTHORIZATION OF EXISTING SYSTEM
Siginature of Environmental Health Specialist Date