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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME I L~"~CGC PHONE # 5/5 4:10 /L/? &
ADDRESS i G`5- I,~oock k-r~- Id C_ A F V. 1~ •C . 2-z5- Z
NAME OF MOBILE HOME PARK OR S/D Z f
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN?)
PROPERTY LOCATION: STATE ROAD NAME AND #,S;',- C~ /-2 ;3
PURPOSE OF-INSPECTION:
The aforementioned site has been evaluated by tt Rarne f ounty~ealth Department
Environmental Health Section, At the time of inspection, there appeared to be a septic.
system serving this site. If this system should malfunction, the owner is responsible for
any necessary 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 EE 5' FROM-ANY PARS OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON'SEPTIG SYSTEM'..,'
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AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
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Date