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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME k% &.,..,r.( e' PHONE #
ADDRESS 2)-)-0 2 )-10 t(%CG �a i& -d � AV C � S3 -moi
NAME OF MOBILE HOME PARK OR S/D /VX / p
NAME OF OWNER (IF DIFFERENT) `J-(� (ipp( J �, .n fy f-nCZ
ADDRESS OF OWNER (IFDIFFERENT) 2 t) 7 4r;�4 1 d?,
PROPERTY LOCATION: STATE ROAD NAME AND #L. -
PURPOSE OF INSPECTION:
The aforementioned site has been
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
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AUTHORIZATION OF EXISTING SYSTEM
Signa ire of Environmen al Health Specialist Date