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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 9h'72'1--' l.~s! Ls PHONE # ;rlq dss'Y~Z9~'7
ADDRESS ZS ZD b ZJ:614 1~-b C,ra--s / c. .1 "I E. ►
NAME OF MOBILE HOME PARK OR S/D Jr,~)F - 6fh- rJ let
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # -&t /:57/ / 3aa /d y /Zb
PURPOSE OF INSPECTION: 7-0 i3r ii~v -tT
The aforementioned site has been evaluat byte arne 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 i
any necessary repairs.
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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
AUTHORIZATION OF EXISTING SYSTEM
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S' ature of Environmental Health pecialist Date
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