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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # ?16 !Z ~ ~77-
ADDRESS 106 -2
ST Ir vt- /~L 4,~ S /F .r1lp, , /~J ~jf
a ~ ~i -aw / " ! 1 ~ Zf
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 5,1-76',- IgJ~~ _
The aforementioned site has been evatuated by the Harnett County Health Department
Environmental Health Section. At the tlme of Inspectfort, there appeared to be aseptic
SYstertl suing this sitar; if this system should maHunctfort, 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 MAST BE 5 FROM ANY PART OF SEPTIC. SYSTEM
00 NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
S ~tureof Environmental Health Specialist
Date