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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS'T'ING SEP'T'IC SYS'T'EM INSPECTION
NAME / S PHONE #
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ADDRESS y a 5 _ ~,,rar ~ L4' James t, 2 7, l~ l <v
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) Ln ~-c
ADDRESS OF OWNER (IF DIFFEREN7) Z- 3( Ti°•y r,, r-,Il /o - 2 ZSZ
PROPERTY LOCATION: STATE ROAD NAME AND # _~'c jq/ c"A
PURPOSE. OF INSPECTIFO.N:
The aforementioned site has been evaluated e RJfnei-un y~TeaTfh Department
Environmental Health Section; At the time of inspection, there appeared to be aseptic, system serving this site. If this system should malfunction, the owner is responsible for-,,
anynecessary.epaq~~:
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 5F ROM SYSTEM
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DO NOT DRIVE OIL PARK,ON SEPTIC SYSTEM'
AUTHORIZATION OF EXISTING SYSTEM
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of Environmental Health Specialist Date