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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME \44sr-v~5 PHONE #
`11o-3p~-3(~6n
ADDRESS t 5-a, SoN-t.p, C,~ S ~02n i) G
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # L ,,TE2ig 15 4
PURPOSE OF INSPECTION: Mod a L ~7 ^jti fZ GrJ
the aforementioned site has been evaluat byte Harnett oun y 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 MUSS` BEY FROM ANY PARS' OF SEPTIC SYSTEM
°f
00 NOT DRIVE OR PARK OIL SEPTIC SYSTER
AUTHORIZATION OF EXISTING SYSTEM
Signature Vfnvironmentaironmental lth Specialist ate