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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME r k ~z, - 3r~ PHONE # ~it9 8~
ADDRESS 01-T-2 ;t4 nT 64.
NAME OF MOBILE HOME PARK OR S/D 4,4; NAME OF OWNER (IFDIFFERENT) /1'j,,,-
ADDRESS OF OWNER (IF DIFFERENT)s'~~,~,~~~~~
PROPERTY LOCATION: STATE ROAD NAME AND #
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of Inspection, there appeared to be a septic a
system serving this site, if this system should malfunction, the owner Is responsible forli.
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
UZATION OF EXISTING SYSTEM
of
Health Specialist
2i,2AQ y
Date