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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME T,J~~ PHONE # 110 -S57-( 788
ADDRESS /7/3 A)G 55 W FS r
,,w s • e . ~7s Z /
NAME OF MOBILE HOME PARK OR SID /A-/
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # --~cps-~rZ 0.4~C 6;vim cz R,/D
PURPOSE OF INSPECTION: i+a
The aforementioned site has been evaluated by the arnet oun y eaepatment
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
8- /'~-10
ature of Environmental Health,Specialist
Date
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