ETHTE# (HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME j A cG k PHONE # ck19 ql),(,q7 q
ADDRESS 504
NAME OF MOBILE HOME PARK OR S/D ? / CC- L. t- ~
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # -Aq iS
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
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
of E Lenta~lu e Specialist ~C
Date