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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# c716- P72-Z~>S 7
ADDRESS ~ 6%d&,,, Zb i~ O /v
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND /ge _ Lam; ceicer~ ~
PURPOSE. OF INSPEGTIOIY; /~4, l
The aforementioned site has been evaluated b tie-Rarne"
y noun-~y-lfeaffh Department
Environmental Health Section. At the time of inspection, thereappeared 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
i„
- BUILDING:.MUST DE.5'.FR®M ANY:PART OF, SEPTIC SVST,EM 3. .
DC NOT DRIVE OR PARK ON SEPTIC Sl(STERy,r
AUTHORIZATION OF EXISTING SYSTEM
6
of Environmental Health Specialist
Date