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HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME _'_J725 -V16 (// :f( Z�jt� PHONE # f7j— Sri 3yDd
ADDRESS 001 Y%Z , Z2t.Ft;.J 4� F-,, V, /Lir C. ZZt�(,
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #ey(/i//Z (,ds,Lu,h/ -'
PURPOSE OF INSPECTION:
The aforementioned site has been evaluate by t e. arne oun yt a fh 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
Specialist
/D
Date