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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME d5s F % n ,N c u PHONE # t , Ssa $S iq
ADDRESS 4 V- , KNcv c-b,&Qz - C,ctGZ ~ v ouRy -V'0'0-"(N NC. ~15
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7) 4 CS
N6Sc3orres~ C, ALE `'v
ff Qvay ~0~2-1~ p~ C,
PROPERTY LOCATION: STATE ROAD NAME AND # FFeqvbi a7s~
The aforementioned site has been evaluated by the Harnett County Health De artm
Environmental Health Section, P ent
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
f DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of Enviro emn n
RL
1463
Date
Specialist