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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Lo-r-r-, PHONE # TT 1 3- oZE LG
ADDRESS
NAME OF MOBILE HOME PARK OR S/D L-, t- (Q
NAME OF OWNER (IFDIFFERENT) L. t ,,,,L-P,4 ff
ADDRESS OF OWNER (IFDIFFERENT) ~;kT,S ((`,,,j.,E'-4,
PROPERTY LOCATION: STATE ROAD NAME AND # ~2c
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
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 PARS` OF SEPTIC SYSTEM
DO NOS DRIVE OR PARK ON SEPTIC SYSTEM
fi
UTHORIZATION OF EXISTING SYSTEM
agnature of E ironmental Health Specialist Date