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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
ADDRESS -14 1%LG
PHONE # g/S -~f`Z- 27 Z O
NAME OF MOBILE HOME PARK OR S/D Co`Fqz--o Z-7
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 2,405
PURPOSE OF INSPECTIONO
The aforementioned site has been eva~
s am Po un
ea Department
Environmental Health Sectlom At the time of lnspectto'there appeared to be a septic .a
system serving thI t site. If this system should maltunctiorh the owner is responsible foal;
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
D NGT DRIVE OR PARIS OIL SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
'A 14 i /1, . , iZ'~-
- - -/6
of Environmental Health Specialist Date