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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME c~. PHONE #
ADDRESS 227t> , /ms s }C I2P5 r2ox3-b e~-f5 p C Z75-Z1
NAME OF MOBILE HOME PARK OR S/D 2 G~ti
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ao z/~, s X 5 X209
PURPOSE OF INSPECTION 5 C) X ~j 0jo43 °T y ° aU~t 4. Zoo t>
The aforementioned site has been evaluated by the arne t oun y 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
C-/ 44-0
- /_G(P _
of Environmental Health Specialist Date