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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # S15 - 96 $ - 2 yf3
ADDRESS zz z 2p_ #-5 ►2f~ 14-61 tt. /V I C, 775-yo
NAME OF MOBILE HOME PARK OR S/D Z_
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) Z -2 7- L4&tt,~, sza=az ,0 ,C , zrsyo
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PROPERTY LOCATION: STATE ROAD NAME AND # 54,41141 - 6e4Yt-5 AZ
PURPOSE OF INSPECTION.
The aforementioned site has been evaluate byte arne oun y 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 oviner 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
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
/-D
Date