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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # -fl S - 21 o I Zl
ADDRESS ► 3 4 ,S to 06uA l.*,,)4 /Zb S Z.'
NAME OF MOBILE HOME PARK OR S/D ~S Gnu r,z., 5 h~ i 7
NAME OF OWNER (IFDIFFERENT) ,Cqk~L.~ ,D
ADDRESS OF OWNER (IF DIFFERENT) /7y /3fV9 6e4-'5~ C% ,4?q _ Al Z2by
PROPERTY LOCATION: STATE ROAD NAME AND # _~5< 1y.?9 w~ j)e7),j ~
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated byte i-r-ne-ffZo-u-nTy-H-e-afth Department
Environmental Health Section. At the time of inspection, there appeared to be, aseptic
system serving this site. If this system should malfunction, the owner It 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 MAST BE gt FROM ANY PART OF SEPTIC SYSTEM
DO HOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
2
2-Z7-0
of Environmental Health Specialist Date