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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ,~S,~En1~ ~'_s~,.nrs.•~~ PHONE # ADDRESS 27';i
NAME OF MOBILE HOME PARK OR S/D Z.
NAME OF OWNER (IF DIFFERENT) - ~ j e Z'cQ-
ADDRESS OF OWNER (IFDIFFERENT) Z,~ N- C, 275-Z~
PROPERTY LOCATION: STATE ROAD NAME AND #/yse~ r~
PURPOSE OF INSPECTION: LL. r v ` v.
The aforementioned site has been evaluated byte arne un 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 Cr~1Ns~~2~"'
(2) the system should fail or malfunction, and/or
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
(3) the owner or tenant of the property changes, and/or
(4) after six months
AUTHORIZATION OF EXISTING SYSTEM
4e--_-7 zof Environmental Health Specialist
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Date