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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~L,,3~A C,,,-&Lf" i t s PHONE #91S-,77Z- ?7-Z&
ADDRESS Zl t 7 /,Pz,,-70 2 ?7-2-"j
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT) 1LG V ~efl12-0 i G ,fi
PROPERTY LOCATION: STATE ROAD NAME AND # 5~-7l /Y15
P1
jRP0SE_0F INSPECTIONS ~k <.s
The aforementioned site has been 6910-
tey t e arneoun y eaii Department
Environmental Health Section: At the time of mspectlon, there•appeared to be a septic =
system serving this site4 if this,system should. malfunction, the owner (s responsible for-1
p _ • . any~pecessary re airs y r>
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 PART 01° SEPTIC SYSTEM
DOS ~[4~' DRIVE OR PARK QN'SEPTIC~SYSTEM~
a,.~ ,
AUTHORIZATION OF EXISTING SYSTEM
2--Zt 12-
of Environmental Health Specialist Date