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HARNETT COUNTY HEALTH DEPARTMEN'T
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
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NAME -j cl~-)' e C--,-( PHONE # 26-,P5
ADDRESS r-'b , (~,Y i 13,u,~, S G _ k) C--a 5Z>C',
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREIVT)
ADDRESS OF OWNER (IF DIFFERENT) &T'4_'3 4-(-fp~6 fi- S /)/°Z a r"
PROPERTY LOCATION: STATE ROAD NAME AND # ,f5 yy
PURPOSE OF INSPECTION:
The aforementioned site has been ev luated by the 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 OF EXISTING SYSTEM
S
3 - -z-2--t
of Environmental Health Specialist
Date