ET RHTE# U 503 O G 5
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ` G •f ~ C SSA PHONE # X10 - -181L
ADDRESS ~ Ll j 0-y-PLA c
NAME OF MOBILE HOME PARK OR S/D J,~ f `-"7 L
NAME OF OWNER (IF DIFFERENT) S~C
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE OF INSPECTION. .9 Yk "1 J_ _ r ~-,A - ,
The aforementioned site has been evaluate byte arne County-H-ea-Ith 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
(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 PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
S
of Environmental Health Specialist
Date