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HARNETT COUNTY HEALTH DEPARTMENT
ENV)RONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ' atj 5je C & PHONE # 77-Y- yZZ- /6-77
ADDRESS X53 �1�x�,n..) CAI4�C �6R %jl N.C. 27S7L&
NAME OF MOBILE HOME PARK OR S/D �%2PfGthiFrJ (�lreS
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #yQ/ ,j
PURPOSE OF INSPECTION: 357cZS'�
The aforementioned site has been e oun y ea evaluate byte acnDepartment.
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If this system should malfunction, theowner 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