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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ,d-q1,4Ac l~Afl~~/~
ADDRESS hp~~ Ck~
PHONE # _ L~Z- S67
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) C,, AAr-~ 1144 f ,l re l ~f~usJ lc
ADDRESS OF OWNER (IFDIFFERENT) 41y,) /V
PROPERTY LOCATION: STATE ROAD NAME AND # !'in 41o,) d
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated by t O arne oun y 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 Oft SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
/ I A
Environmental Health Specialist
D
Date