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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME, t; - PHONE # E! z q `11, 3
ADDRESS 6C~, L ~ , D f=~t~ , C C L V30 (e--
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
4
PROPERTY LOCATION: STATE ROAD NAME AND #L/
PURPOSE OFINSPECTION; , t~Y.. 1r>~ > • r~
The aforementioned site has been evaluated y^tiheTarntoun y ealth Department' ;#f
Environmental Health Section: At the time 6f inspect on; there appeared tote a septic
j. system serving,thissite: If this.,system shouid malfunction,-the owner is responsible for..;
} an(~v~n cessa reairs~ t
t ~ a 5 ' yr a , y;' e € a tr z a V xp,
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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
BUIE:DINGMUST BE~5FROM ANY:PART OF. SE~J. IC=SYSTEM0 NOT DRIVE OR PARKQN SEPTIG SYS~`EM
f, k t
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date