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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #
ADDRESS'w /15 & Au a��/�. AIW.Gi —2 75[Z/
NAME OF MOBILE HOME PARK OR S/D 4/4
NAME OF OWNER (IFDIFFERENT) sa^�//
ADDRESS OF OWNER (IFDIFFERENT) )y��6 DDIS
PROPERTY LOCATION: STATE ROAD NAME AND # D 4i -- A &A- 14j
PURPOSE OF INSPECTION:
The aforementioned site has been evaluatf3d byte Harnett County Health 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(
S n ure of Environme I Health Specialist
EXISTING SYSTEM