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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME f L,~ cry,J . PHONE #r
I
ADDRESS d . z` I !~z CCU C' ~ ~t? . C . 2-7-S-4
NAME OF MOBILE HOME PARK OR S/D 5-,, ,,,mss., L.&-iL S
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IFDIFFERENI)
PROPERTY LOCATION: STATE ROAD NAME AND # s7,L 1'5-3`( ,,?-D
PURPOSE OF INSPECTION: / X ? _
The aforementioned site has been evaluated by the Harnett oun y ffie-alffi 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 DUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
3v - rv
ture of Environmental Health Specialist Date