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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 'kZ¢r1i11' - -/- 7J;4 4- PHONE #
ADDRESS I1tg;;,50 N G 21 b ,�fj W • C. 7 ?tea 7
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # /4-E vv Zl p
ISEOFINSPECTION: 1�razrll')r�
nentioliecCsite hasbeen evaivate, y t e arne oun y ea Department
enta Heal fi Sectio n. At Ehe timE3 of., nspect[oh,, there appeared Eo be aseptic
ving this site. If this systemsfiould:malfunctiorr, the'owner is responsibie for :'
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