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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME _ 4A4 A Fhrf)r,~5 PHONE # --1 /1) ADDRESS IZrc -e Cr- C Z-7 S Z
NAME OF MOBILE HOME PARK OR S/D Nokr4Ws7-1 5 c Z
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # sn i 14 q J r3,;-0 h~5 6" We jz- D
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PURPOSE OF INSPECTION: 4 j ; f .
The aforementioned site has been evaluat by t e arne)` ~ noun ~ a ~Yepartment
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
AUTHORIZATION OF EXISTING SYSTEM
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of Environmental Health Specialist
Date