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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 2a&^~{' PHONE # ADDRESS 3yoS o r r> >3uiP_5 z6 _ C. Z~ Sa
NAME OF MOBILE HOME PARK OR SID 3
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 67t-- i5-1 Z
PURPOSE OF INSPECTION: Ar- 6
The aforementioned site has been evaluate } t e acne oun ea Department
Environmental Health Section. At the time of inspection, there appeared to be s septic
system serving this site. If this system should malfunction, the owner is responsible for
any necessary repairs.
U n)r~c_,E, L~
44
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 5FROM' ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date