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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Q)7 6V PHONE # g/ IYI c2 Q/
`y
07
ADDRESS 107 eani2lon P C Al 31~) lO
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # X01 Ioto 4 A"ll Yl on Grove-
PURPOSE OF INSPECTION: - 6
The aforementioned site has been evaluate byte me 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
D4 NOT DRIVE OR PARK ON SEPTIC. SYSTEM
Signature of En
vYc«au3t
Date
AUTHORIZATION OF EXISTING SYSTEM