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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME P D,t PHONE # 5'6 - 7,V6 - Rs, 31
ADDRESS Z3-71 ~ i l~n~,~-c 17b Z11 C Z?S'Zlo
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ~Sg /yZ -7 gam{ e6
PURPOSE OF INSPECTION: ids eeo>w /
C~ T
The aforementioned site has been evaluated by the Harnett County Health Department j
Environmental Health Section: Attie time of fhspectfom tl ero appeared to be a septfc..
system serving thi19 0. Itthi's system shouldmalfia"Cubm the owner Is responsible forj
and 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' FROND ANY PART 0IF SEPTIC SYSTEM ,
DO NOT DRIVE OR PARK ON SEPTIC SYSTER
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist v Date