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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME .1a 2~S i ~(~H A s icy PHONE # -)03-4110
ADDRESS 15p3 N eSaRgG R~.,,n Segjm r. 1- *a~ NC,
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NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # S AV w N Q
PURPOSE OF INSPECTION: H "1 M G N Q i' r,
The aforementioned site has been eva uat a arne oun 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
UTHORIZATION OF EXISTING SYSTEM
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Signature of Environmental Healt pecialist a e