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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 910 g~P - 6 S6 /
1375 Sao - v979
ADDRESS L'Ee2l~c.,,` 4~ /J -e 7- -251~
NAME OF MOBILE HOME PARK OR S/D wc~, y ✓c,, f u c'o F Z
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #<;~2 /D /fl,a' cw 5 ,
PURPOSE OF INSPECTION: M 4~ f
The aforementioned site has been evaluated by' t e arne t oun y -affh Department
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
re of Environmental Health Specialist
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Date