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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME C,,toa r- r4 S'i ~%e f2 PHONE # j~ r ~?U - y y
ADDRESS 5 'CIS 01 D
NAME OF MOBILE HOME PARK OR S/D rbJ/ i~/~jL Z-
NAME OF OWNER (IFDIFFERENI) i?-01 fCcSi j~
ADDRESS OF OWNER (IF DIFFERENT) 35 IJZA~,ej 577 ee- % /1i,Z , Z7,t~,
PROPERTY LOCATION: STATE ROAD NAME AND # L J ~ Z In e-tc-
The aforementioned ste has been ev
aluated_by the~FTarne:6aun y ea h department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If this system sh"ould malfunction, the owner is responsible fore';
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 BE 5' FROM ANYPART OF SEPTIC SYSTEM
DO NOT DRIVE 0R PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
S,Z1 - I-&
ture of Environmental Health Specialist Date