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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME L. C--. 4,,,,1A J,
ADDRESS G 7 t u~ ~r . v p V C-1 ,t
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
PHONE # Ct 1 ~ a ~ ! C t e
ADDRESS OF OWNER (IFDIFFERENI)
PROPERTY LOCATION: STATE ROAD NAME AND # -J-tr
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of Inspection, there appeared to be a septic 3.
system serving this site. If this system should malfunction, the owner Is responsible for
any necessary repairs. a
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 AN PART OF SEPTIC SYSTEM
DO HOT DRIVE OR PAR 'ON SWIG SYSTEM - 'a
AUTHORIZATION OF EXISTING SYSTEM
/2
2c/2C
Date
vironmental Health Specialist