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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME b~ 0, PHONE # ADDRESS ?.o 2r Z j 9& gj R; C- L-,~-2-3 S
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) '~-1 C L3 5 C
PROPERTY LOCATION: STATE ROAD NAME AND # 5,k_ j 5 s--, j12 0
PURPOSE DF INSPECTION: _
The aforementioned site has been evaluated b the i rnetf~oun y earth 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 owneris responsible for
any pecessary 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,ANY'PARTOF SEPTIC SYSTEM
DO NOT DRIVE OR PARK 0 SESYSTEM„ =
AUTHORIZATION OF EXISTING SYSTEM
'3 - 3o -jam,
ature of Environmental Health Specialist Date