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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~5ftrn,~ Ids P~ PHONE
ADDRESS 121 N /),C- 2 7 ; 6 /
NAME OF MOBILE HOME PARK OR S/D bAY )r- GJ ,✓~a S//J ( /y
NAME OF OWNER (IF DIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # f60C~ 1St~~ S,'
PURPOSE OF INSPECTION:
The aforementioned site has been evaluate byte Harnett Couffy--i'l-e-alffi Department
Environmental Health Section.. At the time of inspection, there appeared to be a septic
system serving thie 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 MAST BE 5' FROM ANY PARS` OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM!
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
3-6
Date