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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~ ~ c- n•, r . /'I G o.re
PHONE # E C,3 - ~ Z Z- C C Z8
ADDRESS C. g 1
NAME OF MOBILE HOME PART{ OR S/D TL- y~ r ra L,4 3
NAME OF OWNER (IF DIFFEREN7)
ADDRESS OF OWNER (IFDIFFERENI)
PROPERTY LOCATION: STATE ROAD NAME AND # 14 ~ I
PURPOSE OF INSPECTION: I ce l1 ~ /--Q--
The aforementioned site has been evaluated by the Harnett County Health 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 R PARK ON SEPTIC SYSTEM
, rr AUTHORIZATION OF EXISTING SYSTEM 11-7 /---/'Zof ~1/r -7 Environmental Health Specialist
Date