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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Q D 1 .T76FF-7- C' Zezr PHONE # _9/I' - Jf-7 7 - 6 jL?
ADDRESS 35-5- V.rc a )q 9-,- 11 5 8•t, s C' V . fU .C 275-26 -54J'
NAME OF MOBILE HOME PARK OR S/D tl.~ 92-
NAME
OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND
PURPOSE OF INSPECTION: t T>I*
The aforementioned site has been evaluated byte R-ar-n-e-ffZ-o-u-n1yTF6a-ffh 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 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
,0
of Environmental Health Specialist
e-4611--T
Date