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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Z &e ri c /�c�C�IS /U. C. PHONE # g/ g-111 Z -OZ k
ADDRESS 302 j VZt4 • f1ti�„ / r/ N C Z-7603
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) .iN"
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # & 2A) e4
PURPOSE OF INSPECTION: ZO k3y Xiu� l �G%tye.
The aforementioned site has been evaluated byte Harnett Cdun y ea Department -i
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
.24"d -S
of Environmental Health Specialist Date