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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME %'VL`ctlffi-,l 5kcA,J PHONE# -5'15- YZ7 -331.3
ADDRESS -711 rccP..y e� . �Z.D /�i l fJ /U • C • Z75-0/
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND
PURPOSE OF INSPECTION:�-
The aforementionkSite has been evaluated by t e arne oun y HeaDepartment
Environmental Realtft Sectioir: Attfi� , nspectlotl,, there' appeared to be a`septio ,<
system serving thid site, If this system should:malflinctiort,th'Owner is responsible for
anysarjF repalrs
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
-moi
of Environmental
Specialist
Date