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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 7 r~ PHONE # 84, 2-03 - 36' (
ADDRESS 2 3 ! I~ n~,,l ►v~. Q , 5
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) / ~ -f
ADDRESS OF OWNER (IF DIFFERENT) 1-J-76 /Zrb Co-*--4 rv . C . ~ -7 5- Z
PROPERTY LOCATION: STATE ROAD NAME AND # ~f2 !`~'7.
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PURPOSE OF INSPECTION: ( X 3S
The aforementioned site has been evaluated by a Harnett oun y ea 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 BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYS'T'EM
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re of Environfrnental Health Specialist Date