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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME I~ PHONE #'916) 457-`f52
ADDRESS 15-q /v, C Z83 y
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) Jb,y,Jr,~ 2
ADDRESS OF OWNER (IFDIFFEREN7) 470 bve,,--mb lSyw,s . c . Z° ~Jy
PROPERTY LOCATION: STATE ROAD NAME AND # 52 zo i Z 1) u K~ 2~
PURPOSE OF INSPECTION
The aforementioned site has been evaluated byte Harnett oun y ea Departnf6nt
Environmental Health Section. At the time of inspection, 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.V FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEI4
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
'7- S-
Date