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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME , ' / b t/-1 5 PHONE # 5/0 3 7 - 7 6-Z- 3
ADDRESS 5-7,3 /2-J) i)u /u,J N . C . Zg 33 z
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) 4,2L f Cft
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # -SiZ Zao z.C~eslJG C/I~0.-'G!f ,Zl~)
PURPOSE OF INSPECTION: P ~ ~4147 11 c-? . .
The aforementioned site has been evaluate byte Harnett County Hdalffi 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.
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THIS INSPECTION IS VOID IF: 4.4 Leo klo ~'o i3~ ~,vcov~, ~ -TF (1) the intended use of the septic system should change, and/or ray,, d/+-~ ql
(2) the system should fail or malfunction, and/or . &I-1) 1~"6
(3) the owner or tenant of the property changes, and/or ~~r cJ wY, s , 6,,, jt ,F4- F .
(4) after six months o j~~ p~ r,~>yS
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BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
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AUTHORIZATION OF EXISTING SYSTEM
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of Environmental Health Specialist
Date