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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME rC~v SC-e~ PHONE # r7ro - 2&5-- 5 2- 7
ADDRESS -7-73(o f Vd l rZ V a - ZZs Z~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) ,vim --j ewe-
ADDRESS OF OWNER (IFDIFFEREN7) 5 f vas(.471 Zidc~ Q~i ry111 zc~kN
PROPERTY LOCATION: STATE ROAD NAME AND # t{z~ q t 1,)
PURPOSE OF INSPECTION. I+vn Apt-A,- YA,,P The aforementioned site has been eva uat by t Harnett oun Health Department
Envir®nmental Reafth, Sectfert.. At'the time of Inspeotlort, there appeared to be aseptic f
system serving this sita► If this system should malfunotiorh the owner is responsible for
f.. 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 BUST BE 5' FROM ANY PART OF SEPTIC SYSTEM,
D NOT DRIVE OR PARK ON SEPTIC SYSTEM.
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date