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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME/1 :..
ADDRESS a s 9c-1 OLo� �c ,'�i9 .,� V e!!�tl,C' •'] 7ti O I
NAME OF MOBILE HOME PARK OR S/D /✓Q
NAME OF OWNER (IF DIFFERENT) :2&✓e I",& -e -
ADDRESS OF OWNER (IFDIFFERENT) IIG"At W.
PROPERTY LOCATION: STATE ROAD NAME AND # 4",(b did
PURPOSE OF INSPECTION: Clffl !�S `
The aforementioned site has been evaluated by the Harnett Coun—ty—Tte—aftDepartment
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
AUTHORIZATION OF EXISTING SYSTEM
of Environmenfal Health Specialist
Date