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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS'T'ING SEP'T'IC SYSTEM INSPECTION
NAME PHONE # W -135S
ADDRESSES- C
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENI) l~~+-L ( -FS
ADDRESS OF OWNER (IFDIFFEREN7) 4:bc I3~s>~s6w 12--6 4t, /Q, ('7-?s-e)
PROPERTY LOCATION: STATE ROAD NAME AND #2 (2-b
PURPOSE. OF INSPECTION:
The aforementioned site has been evaluated bytheHaarne 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 5r FROM_ANY'PARTQFSEPTIC SYSTEM. DO'NOT DRIVE ®R PARK QN SEPTIG SYSTEM:. .
AUTHORIZATION OF EXISTING SYSTEM
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ature of Environmental Health Specialist Date