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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAMES LEL f,~~c.~ 5 PHONE # ?lo F `laaa
ADDRESS 7 i L 4s~. t
NAME OF MOBILE HOME PARK OR S/D SIZ> 6., / Z
NAME OF OWNER (IF DIFFERENT) ~)jY1eSh _ Y
ADDRESS OF OWNER (IF DIFFERENT) Z-7
PROPERTY LOCATION: STATE ROAD NAME AND #.,1k 3 ~tkzlls 0)
PURPOSE OFINSPECTION;
The aforementioned site has been evaluat 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
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
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9-!,
of Environmental Health Specialist Date