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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME :5ha� <c �p PHONE# %/%3o?-�il3y
ADDRESS 1/9 / i r7 �i.` ✓ C`.F i1 A � _ /t -,14-- / kV,) 2 7/-e) 3
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) 6i' yR Y- ley
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE OFINSPECTION: -41
The aforementioned site has been evaluatedby the7rame ouy ealth 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
of
AUTHORIZATION OF EXISTING SYSTEM
W-4�`./.
Specialist
Date