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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~ C-~ a \ /10 jPHONE # f -'O`'
ADDRESS ~:7 S
NAME OF MOBILE HOME PARK OR S/D ~S ,t y 3 o
NAME OF OWNER (IF DIFFERENT) 541-^e-
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND - --1/,2 //42a/ Id
PURPOSE OF INSPECTION: I-/ . f
The aforementioned site has been evaluat y e arne County 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
L ~ 02 )r-D9
Sign-se of Environmental Health Specialist Date