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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME // f 6z,�Jee,�' CA oww PHONE # 9/9 - yoo—Sy/3
ADDRESS .305
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NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #&4gzzSj/
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The aforementihscsite has been evatuats }rt e,Arne aun ea De arfineni _Y
Envtrarimeitta Healh� Section: 11t this tltii ofnspsctCh, tier"e appeared to be a septa
system serving ttitslte, If this systertl shoul,`malfunctlotr the owner is responsible for
a(y
nnecessa repairs y z
S
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
3- t1—/('
of Environmental Health Specialist Date