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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME CXft,, Lif- ~ PHONE # 9/ q - G 35-19 S G
ADDRESS Z 3 ~ jAle-d 1~~x1~S 1C~ l~ i~ U '7 -6-D
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NAME OF MOBILE HOME PARK OR S/D J kjs ,
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #.,5A 11-13y I1)1A
Drsc~ss`J Lzx~-nt
PURPOSE OF INSPECTION. s54 ' C7 Ou r.e f ,pccess
The aforementioned site has been evatuat 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 Y FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
C)
Date
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