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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #J /9 " 77 y- 8721
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ADDRESS s s" ~,f,,.~,~„,~,J /.g,.,e huN,•> N C z 833N
NAME OF MOBILE HOME PARK OR S/D TZ, Cst A
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 52 /70'5- 6I1)
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PURPOSE OF INSPECTION.
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The aforementioned site has heart evalua byte erne oun y ea Department=
Environmental Health Section: At the time of lnspeWok there appeared to be a septic 4;
system serving thin 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 MUSS` BE 5' FROM' ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
C d 4~ ~c~s? - ature of Environmental Health Specialist
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Date