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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME h I-tQP0 4 „S i?)K . _ S PHONE 06-6 3S - yB 8 Z
ADDRESS q9 Lr / t y
NAME OF MOBILE HOME PARK OR S/D J Ica h S
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 5K 1!5-3R /~7 /U>
PURPOSE OF INSPECTION: 1~ x . ~rM 4 Tb Ex ~s
The aforementioned site has been evaluated byte arne oun a 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
b- O
Sig ture of Environmental Health Specialist Date
_T9