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HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 41//fyJPHONE #
ADDRESS Zj'— 6u� Cje" h/
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # c5C,. .&Us K/(/e
PURPOSE OF INSPECTION: ZZX 20 `57mu%-e- W/ T; Lech L
The aforementioned site has been evaluate by t e arne oun y ea Ri Department
Environmental Health'3ection: At the time of inspection, there appeared to be aseptic
system serving Mi. site. If this system should malfunction, the' owner is responsible for
any necessary repairs..
THIS INSPECTION IS VOID IF: �y/J
(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