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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 1ZOh ev~.~' r-ej l t, PHONE # !k& -,95n -1371
ADDRESS Z-7s--a 1
NAME OF MOBILE HOME PARK OR S/D /&y c- t-S lo* /l
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
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PROPERTY LOCATION: STATE ROAD NAME AND # ZZ SiV-A 3 /fitye i 7z b
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PURPOSE OF INSPECTION:~
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The aforementioned site has been evaluated by the am t~ oun y~ ea Department
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Environmental Health Section. At the time of inspection, there appeared to be aseptic
system serving this site. If this system should malfunction, the owner is responsible for
any necessary repairs.
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THIS INSPECTION IS VOID IF: cs
(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
neaim 3pecianst
Date
AUTHORIZATION OF EXISTING SYSTEM