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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # ~l g -557 - ~ 77
ADDRESS /ill/ ~iYta.~_vsiyv ,r~iL y N G Z 75 .
NAME OF MOBILE HOME PARK OR S/D Sou7 14 cb6F ~ e nS 35~
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ~fwy ya/.J
ktS~vSSE/) Na k~ ~+c~ab ~
PURPOSE OF INSPECTION: S ra2A(,4- For f~qj~, r'~-D~
The aforementioned site has been evaluate byte arne oun ea Departm6nt
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
i' ature ~offnvironmental HealthSpecialist Date