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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME` PHONE #
ADDRESS 11 yta_
NAME OF MOBILE HOME PARK OR S/D( rW&" L4_.
NAME OF OWNER (IF DIFFERENT) Mr l l of P 11 zalbp 3{x~'
ADDRESS OF OWNER (IFDIFFERENT) P6 F~a rN C~ 11t ~c `n
PROPERTY LOCATION: STATE ROAD NAME AND # l ao~.rD
PURPOSE OF INSPECTION: C t rvt l? n Q_-7
The aforementioned site has been evaluated by the arnett 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
14 AUTHORIZATION OF EXISTING SYSTEM
Signature of EnvironmentaYHealfh Specialist 4 Date