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HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /f~ ~ L° =~,~i -
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ADDRESS /
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERE'VT)
ADDRESS OF OWNER (IFDIFFEREVT)
PHONE # 5/ 5 -73 "2' - 3? tie,?-
C- '7? S'
PROPERTY LOCATION: STATE ROAD NAME AND #,>L l vy,3
PURPOSE OF INSPECTION: `'`''1'-l-~-~
The aforementioned site has been evaluate byte Harnett County 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 SYSTEM
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ature of Environmental Health Specialist Date