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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME kocAN,c C,,-„r uL PHONE #
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ADDRESS a► z -1 0 E A2~►Ec, L 15a-~1
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) S I-)
~N,,E S-•.~~~ 6Z~ ~,r~y oy ~JA2~Nt~ ~JC. ~`15d C
ADDRESS OF OWNER (IFDIFFEREN7'`) S14ELL-i ~'N6r~,aL
PROPERTY LOCATION: STATE ROAD NAME AND # a
PURPOSE OF INSPECTION:
The aforementioned site has been eva uat y t e r-ne-ff oun ea Department
Environmental Health Section. At the time of inspector 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 ON SEPTIC SYSTEM
Signature of
THORIZATION OF EXISTING SYSTEM
Health
Q5
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