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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~ s r P s ~a i Se-ryt C ~S
ADDRESS//A 14
Rd
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) AnyoA'. s p 2 e-~
ADDRESS OF OWNER (IF DIFFERENT) 10 4.5 NEB Grp: 5 I, L4nn
PROPERTY LOCATION: STATE ROAD NAME AND # e~slu
r ISS fi!~•
PURPOSE OF INSPECTION:
The aforementioned site has been evaluat y t e arne oun ea 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
to H-t,PIS,
Signature of Environ ntal Health SDecia
PHONE # g 1 q o 1,1?g ,'2? 3/ 0
Date
0