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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS'T'ING SEPTIC SYSTEM INSPEC'T'ION
NAME PHONE # pia jl
ADDRESS ZSSb, r~ ffr~n~ e in X C Z-7 5 e y
NAME OF MOBILE HOME PARK OR S/D KtoLLq , k,?- g /-*,t t'7
NAME OF OWNER (IF DIFFERENT) 1,1apcC I + F,dar
ADDRESS OF OWNER (IFDIFFEREN7) e* C7' 1W,~3iJ A- C. Z5-33Y
PROPERTY LOCATION: STATE ROAD NAME AND # ('70tf
PURPOSE. OF INSPECTION. ~?~A-~,- e~ L) 11, The aforementioned site has been evaluated by tthe-Rarne ou-nJy-T- eaTfh 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 .;9
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any necessary repairs, j
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 I UST EE ' FROM ANYPARF'OF SEPTIC SYSTEW
DO NOT DRIVE OR PAARK ON SEPTIC SYSTEM ,
AUTHORIZATION OF EXISTING SYSTEM
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of Environmental Health Specialist
Date