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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #'T - 77 - p6 c Z
ADDRESS S% l /LAS Be,~s~ C, 2-7-5-b
NAME OF MOBILE HOME PARK OR S/D J-6 NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 5 /.5w PCIO
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated by the arne County H-ea-ft Department
Environmental Health Section, At the time of inspection, there appeared to be a septic
system serving this site. tf 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
OF EXISTING SYSTEM
AUTHORIZATIONy
4 / '
of Environmental Health Specialist
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Date