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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
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NAME ju.J /FoaIs PHONE # _gs!- 97,0 X Z3S
ADDRESS c ,f /lsbe rte. s% ~a/e ,U C 77C.~n~ ~
NAME OF MOBILE HOME PARK OR S/D Cyzzr..~ ioc ~ ZW
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFEREN7) .15-15- 7760(,
PROPERTY LOCATION: STATE ROAD NAME AND # j2 6SS2 ~~a,~ /r~j
PURPOSE OF INSPECTION:G o /8 x 38 T^' we-~
The aforementioned site has been evaluat y t e arne 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
4 aL-
of Environmental Health Specialist
Date