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HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME &j -ohm (q _4 `.! P_Tps PHONE #/-)/ ge S'I7F-A7
ADDRESS /U C
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 000',j l en ice., /U
PURPOSE OF INSPECTION: 13U►) V S (L()arm ( (A1 v N Aged- ,
The aforementioned site has been evaluate by t e arne oun y a Department
Environmental Health Section. At the time of inspection, there; appeared to be aseptic :.
system serving this site. If this system should malfunction, the'owner is responsible for
. any necessary repalrs.
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
ai�g-rFT
of Environmental Health
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Date