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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME L/t 0n c 2 5~"'- PHONE # ?3'~- W mil- t ~
ADDRESS C-
NAME OF MOBILE HOME PARK OR S/D '7~a I~ fL t-.,,\- '3
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # L~2a w 1 C _ (U.
PURPOSE OF INSPECTION c\ o ^ '4 ) , l(4^/'^
The aforementioned site has been eva uat y t e acne oun 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 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
1 I,
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
1 AUTHORIZATION OF EXISTING SYSTEM
Signature of
vironmental Health Specialist
Date