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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME f~ 1 C e n n n PHONE # 92 p- 1 o 3 -7
ADDRESS
NAME OF MOBILE HOME PARK OR S/D~~,
NAME OF OWNER (IF DIFFERENT) R c,h 4 M Rr-~ n, z- n~
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # Po,\{ L1--zocf
PURPOSE OF INSPECTION: UZ uc- fi c /Yl ti T
The aforementioned site has been eva uat y t e acne oun 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 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
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Date
Environmental Health Specialist