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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME A)knn F,4 C
~t PHONE #
ADDRESS
C '~2 -7
NAME OF MOBILE HOME PARK OR S/D t( Z 3
NAME OF OWNER (IF DIFFERENT) 5N-V -e
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # S~z 0 ! r
PURPOSE OF INSPECTION: 4 ' //1-r, The aforementioned site has been evaluated byte arne oun Fe-afth 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 sic months
BUILDING MUST BE 5! FROM ANY PART OF SEPTIC SYSTEM
DO. NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUT ORIZATION OF EXISTING SYSTEM
0), 9 - z
Signature# Environmental Health Specialist Date