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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME eI M li~-) y \ ioE2S PHONE # ADDRESS (-L`Z-1 G cc-.- !SG
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) L-i r p c tJ AoU N G4,-z) (LA,~ j Q_<►
ADDRESS OF OWNER (IF DIFFEREN7) a-,tj S \f4 ~ Q~ 4b "'3 f ~ NY, 4i-S5.C
PROPERTY LOCATION: STATE ROAD NAME AND # 2C)31 W %oz Z, )
The aforementloned skef has been evaluated by the Hamett County Health Department
Environmental Health Secttori Aftho ttm4 of In
spection% them appeared to ber a septic ,
system serving thiet site, If this system should ma NnctlbM the owner is responsible for i4
any necessary repalrs.
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
BUILDINC3 l~11 E 5W` FROM ANY PART OF SUMO., SYSTEM j~
00,Ngj,DRIVE OR PARK ON SEPTIC SYSTEM
. .
TION OF EXISTING SYSTEM
Signature of Environmental
3
6Q
Specialist