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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # Sib - sG ?~Z/s7
ADDRESS /y713 ~y~,u~ 5~ i2ib ~is~G% N.r. Z"O$
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) Sz C / v.~
ADDRESS OF OWNER (IF DIFFEREN7) Z/0% v ~f f ~•r~v rv,~, Z~~3y
PROPERTY LOCATION: STATE ROAD NAME AND #
The aforementioned site has been evaluated by the Harriett County Health Department
Environmental Health Section. At the time of Inspectlo- M there appeared to be a septic
system serving this site If alit system should malfunction, the' owner It 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 S! FRONtANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC $YSTEIV
AUTHORIZATION OF EXISTING SYSTEM
Siture of Environmental Health Specialist
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Date