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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME {� � 6Z 5 PHONE # %61 �/�7 45 W
ADDRESS 4/70 % VJ, J.41Ak /- o t^ -: PAS,,,, ; ° stz 7
NAME OF MOBILE HOME PARK OR S/D dV 4
NAME OF OWNER (IF DIFFERENT) $a�
ADDRESS OF OWNER (IF DIFFERENT) $c-^4
PROPERTY LOCATION: STATE ROAD NAME AND # T2P?iLLfG c/�i�
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated by ffih—eTFar—n-effL—o—unTy-HeaIth 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 OF EXISTING SYSTEM
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Si tore of Environmen al Health Specialist Date