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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
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NAME p pp f d~.r+t a,.~ So c l~ le i / PHONE #117 - z SS- 8 Yy7
ADDRESS 6 f Kyle stns. ~ I/ 7 75-2 Cr
NAME OF MOBILE HOME PARK OR S/D YS rls AzMr PIV-4 i ss
NAME OF OWNER (IF DIFFERENT) ,j;,A, f f" t ,4v,4 ? l ~1G
ADDRESS OF OWNER (IF DIFFERENT) (o ~e~.r cr A), C, Z-75 P
PROPERTY LOCATION: STATE ROAD NAME AND # S121y5--y G,a•62:!~r(f lZ6
PURPOSE OF INSPECTION: - i C
The aforementioned site has been evaluated byte 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 Y FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
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ature of Environmental Health Specialist
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Date