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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 0'1' q f . , PHONE # jl/q ~-s Z - 9Lao
ADDRESS P. D. f-)-1z31 L' - X). C. Z' -7 5-4;"3
NAME OF MOBILE HOME PARK OR S/D ~%,a Svc
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # -W I Y3 7 &-A f, ~/44
PURPOSE OF INSPECTION L)
The aforementioned site has been evaluated byte Harnett CounTy-Ti-e-alffi 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
A
/ /6 -D
of Environmental Health Specialist Date