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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /�� ��%,v� PHONE # $/Y-639- V8Y7
ADDRESS3`fS K •�t,5 �rcl� /�/Gi//�/r- �re. AJ -C:2 Z-7257271NAME OF MOBILE HOME PARK OR S/D liX-� 13
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # c'V-Hi!DVi * At o 4e, 5 /Zd
PURPOSE OFINSPECTIONX=v�ei
Theaforementionec site has6een evacuateby t e arne " Department
Envirtinlnentat Healil'"Sections At the tine of inspection, there'appeared to be a septic .
system serving this site, If this system should.rnalfunction, the'owner is responsible for ;.
any necessary repairs4 ,
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
of Environmental Health Specialist
Date