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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~ ~ c wt 13"" (l PHONE # ~z 'V qoq - 72 5t
ADDRESS CO ~3 x -~D I &.)A, C41 A, n c-
NAME OF MOBILE HOME PARK OR S/D C~n f
NAME OF OWNER (IFDIFFERENT) 5A,-vt
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ~J/I r ,yrJ
. PURPOSE OF INSPECTION: r . 0'4 /l-kC
The aforementioned site has been evaluated by the Harnett County ea 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 A
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTIJORIZATION OF EXISTING SYSTEM
Signature of/Environmental $ealth Specialist Date