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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME S /f'✓6,J Qud _,a..-~ u S PHONE # 119-S5Z -4169y
ADDRESS 27 (5, C/Rglce Crn oerc. ci 5, , ~ .C Z15-yD 1,44 NAME OF MOBILE HOME PARK OR S/D fir,. n q0
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 1 , y 2. - C14qAe (2fy
PURPOSE OF INSPECTION: ss L, / ~AIJ
The aforementioned site has been evaluated'by the Rarnett ounTy He-aAh 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
z
ature of Environmental Health Specialist Date