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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME _nay PCUI fhUtt'a; �L1,G� (k PHONE#
ADDRESS Snt= ? 11`7 U S"O 1'�
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) 4aA _ L -,P -e
ADDRESS OF OWNER (IF DIFFERENT), Iyg �� �2 �✓, Q `- ���%
PROPERTY LOCATION: STATE ROAD NAME AND # V1C��C�� vyyylA Aml�
PURPOSE OF INSPECTION:i M
The aforementioned site has been evaluated by thearne out ffy-leafth 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
AUTHORIZATION OF EXISTING SYSTEM
of EriviroWnental Health Specialist ' Date