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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS'T'ING SEPTIC SYSTEM INSPECTION
NAME PHONE #
ADDRESS 27q 6116 f*4--'1 iu) t% y C_ x'75"Z~;
NAME OF MOBILE HOME PARK OR S/D
74
NAME OF OWNER (IF DIFFEREN7)
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ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE- OF INSPECTIONS J,
The aforementioned site as been evaluatedhe Harne un~y fleaTth Department
Environmental Health Section' At the time of inspect on, there appeared to be a septic
system serving.this,-site ,If this,system should malfunction, the owner Is responsible for,.;
y `any necessary reairs'~
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6AS 3 / i u l
THIS INSPECTION IS VOID IF: ~.-1-0 rl}F 131hl~
(1) the intended use of the septic system should change, and/or
(2) the system should fail or malfunction, and/or f
(3) the owner or tenant of the property changes, and/or
(4) after six months
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BUILDING-f 8T EE`5' FR~ANYPART"'QF SEPTIC MUM
EM A'
DA`NGT DRI'®R PARK 4N SEPTIG`BM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Sv&ialist
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Date