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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME cl~,4 cc-9...` PHONE # `3 / ~ - -t -N - 'T 8 Zd
ADDRESS /Z8 us hk,,, Z0 r ca-tr ,Je., ) C Z~iS 7-13
NAME OF MOBILE HOME PARK OR S/Dc/s ynb,~ &-e If7
NAME OF OWNER (IF DIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT) 1c Z75?~
PROPERTY LOCATION: STATE ROAD NAME AND # f y, Z Cknj:, LL.
PURPOSE OF INSPECTION: . /
The aforementioned site has been evaluated by the arne oun y ea 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 Environmental Health Specialist
16-27-/t)
Date