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H ARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # ~ c zz - 37° r
ADDRESS -S-3-11 lZ6 f_-L', 62-C - 7-75 Z(,:
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 1D)
PURPOSE OF INSPECTION: . :~q X 3 CAA t.< - / . j`E P
.The aforementioned site has been evaluated by the Harne oun 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 should malfunction, the owner is responsible for
anYpecessarYrePairs;
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 AW PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date