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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME o S e zr~~,~ ~/.9 -c,4 PHONE # q i o - J34,-7 yx y
ADDRESS 230 /)V/ 7~U i Z) 65,,jl-rJ /1 . 2 S 3Z
NAME OF MOBILE HOME PARK OR S/Dak/ ~c ~ILQ 5~
NAME OF OWNER (IF DIFFEREN7) f D'~
ADDRESS OF OWNER (IF DIFFERENT)>9ir~ ,¢wvv L
PROPERTY LOCATION: STATE ROAD NAME AND #,fX
PURPOSE OF INSPECTION:
The aforementioned site has been evaluat by t e arne County 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
of Environmental Health Specialist Date