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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Ke) IV l!( er G PHONE #
ADDRESS _21S f'Y1rt✓t c, L/tr~ l' / ~ /0. C. 7-7-5-01
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 52 i q c s" ttAJt, xAL-~
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section: At the. time. of. there appeared tot* a septic, .
system serving this site It tt1r system should malfunctf6r; the owner Is responslble fob
any necessary repair:
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 S' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARIS ON SEPTIC' SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
-71;-0
Date