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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME C c., t PHONE # c\'~- -76-3- 0 71
ADDRESS AQ ,l
NAME OF MOBILE HOME PARK OR S/D 4a 6-,vt- / 3 j
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENI)
PROPERTY LOCATION: STATE ROAD NAME AND # C.) a y AA The aforementioned site has been evaluated by, the Harnett County Health pepartment
Environmental Health Seclftrf. At the, time of Inspection, there appeared to he-- a septic
system serving this site. If this system should malfu0ctim the' owner is responsible for l,
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 5' FROM ANY PART O SEPTIC SYSTEM
DO NO DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
J
of Environmental Health Specialist
~ ~oc 7
Date