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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
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NAME �y l�r.} ud2 C :& PHONE # %
ADDRESS ,61 I� 17 0!5 ', D {- d /L m-14- AZ, (' 2. 'S S W"
NAME OF MOBILE HOME PARK OR S/D AAA
NAME OF OWNER (IFDIFFERENT) — (�ti t -e�
ADDRESS OF OWNER (IFDIFFERENT) CS �/ Vi d4 -M �jn V-LVIHi kjOj,�933!7
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE OF INSPECTION. /U# -
The
U!# -The aforementioned site has been evaluated by the Harneft-C-o-uhUy-H-e-alth 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.
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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
AUTUORIZAT{IIOON OF EXISTING SYSTEM
of Environmental Health Specialist
Date