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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME-,7-,J/0 L- STE ~JAfLT" PHONE # 919-631-3S 3 1
ADDRESS Z 19 EF T C0-y,z-r /U. C Z7 Sa/
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT) f?d . i~;y-7 ayes 6zeek ,J.c. 7r.~,4
PROPERTY LOCATION: STATE ROAD NAME AND # SSC 15"75 GII ~6I?~
PURPOSE OF INSPECTION e~, 6 if
The aforementioned site has been evaluat byte Harnett CouhtyWea-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
2
of Environmental Health Specialist
-1L-
Date