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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Cr+7L,_ A&I PHONE # `~i? -_7914 -/leg'
ADDRESS Pt~. 6Ux 137`1 / j ti C
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT) 7_ j`7
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PROPERTY LOCATION: STATE ROAD NAME AND # `fit t`j~ 3z oq,& C_u-,2,~)
PURPOSE OF INSPECTION,
.The aforementioned site has been evaluated by the liarnetf unty Freajth 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
BUILDINGNUST..BE5' FROM:ANY'PARTOF,SEPTIC SYSTEM
R.
DC NOT DRIVE CFA PARIS O SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental
1 `7°"-r Z
Specialist
Date