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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION r 9
NAME LJr, RAAn0c.-z; PHONE #
ADDRESS X10 ~ ~ f r Da_ Sra. 0 ")-7 -3 1
NAME OF MOBILE HOME PARK OR S/D C. (--c)k
NAME OF OWNER (IF DIFFERENT) Sr)(~
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # / I i
PURPOSE OF INSPECTION: `'t I
The aforementioned site has been evaluated by the arne t 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
Signature g 4Qr H
-7-~-\o
Specialist
Date