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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # t Z_-j
ADDRESS (g,- IP)__~ /QC.', 2,_1 i-4",i C76 t ('L r -
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT)`~ 6 r2l, Lam; i
PROPERTY LOCATION: STATE ROAD NAME AND # (-7~,
PURPOSE. OF INSPECTION: - x a , v l 7+7_ /mil f r i ~
The aforementioned site has been evaluated j e Jarne~ounty~Teajfh department`
Environmental Health Section. At the dime=of inspection, there appeared to be a septio
system serving this site ,If this system should malfunction, the owner is responsible for?
ncreccani r[ina~te> A. r.~
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
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BUILDING MUST DE S' FRQN9 ANY PART OF: SP.TICavSYSTEI
E DQ=NOT, DRIVE Qty PARfx Ql SEPTIC{ SYST
' EM
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AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date