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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME _J (f t --i,` � dhn1Sd1J PHONE # il�-7Z3
ADDRESS Z57)f) % r9 {�a r� e E� L I L%J �� . C.
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 240,,J
PURPOSE OF INSPECTION: 14(y5-& � �Ap�odr �
The aforementioned site has been evaluate by t e arne oun y ea Department
Environmental Health Section. Afthe 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
S L, -- - -- - 12-1
of Enviro mental Health Specialist Date