ET RHTE# /d (XL O0 /$ie
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAMEPHONE#�J0•, ,09-/,5R,;"
ADDRESS
NAME OF MOBILE HOME PARK OR S/D AAP
NAME OF OWNER (IF DIFFERENT) .Mo- _r4',l 4"y t
ADDRESS OF OWNER (IF DIFFERENT) A)b� & VW
PROPERTY LOCATION: STATE ROAD /NAME AND # Rat"
M
PURPOSE OF INSPECTION: I ' � IT " ��
The aforementioned site has been evaluated by thearne faun yT—Heaa1th 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
s
SloWature of Ei
AUTHORIZATION OF EXISTING SYSTEM
x/,
Health Specialist