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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #%16 -9~7 - /y83
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ADDRESS /33G ,(IFZ6~ l~vN~ ~,c 2 ° 33~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # S21?o 7
PURPOSE OF INSPECTION: AuL7-zW ST~arc
The aforementioned site has been evaluated by the Hai metf County Health Department
Environmental Health Section: At the time of Inspection' there appeared to be a septic,
system serving this site, If this system should mairurlctloM the owner Is responsible fo,, `
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 S! FROND ANY RARE` OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEW
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Y-i
Date