ADDITIONAL INFOHTE# �(^� /Sy
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME �[2��aIt S/ �� n (/cam P PHONE # 5/ % 7/-6,Vl
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT) Dc—
PROPERTY LOCATION: STATE ROAD NAME AND # lye
PURPOSE OF INSPECTION:
The aforementioned site has been evaluate b—y—t—h—e-Ra—r—n—eff-Co—u—n—fy-Re—a-fth 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 OFEXISTING SYSTEM
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O_/✓� ��Z. h! S ,ass/1?/20>i
of Environinefital Health Specialist Date