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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # -'a' 4
ADDRESS
NAME OF MOBILE HOME PARK OR S/D ROU~WG'1Aycs S~ 4,S t1 Qv
NAME OF OWNER (IFDIFFEREN7) C*mr--,.,, Rsc.,N4,i5
ADDRESS OF OWNER (IFDIFFEREN7) 5 D Nva~,F1ar Q o SPe, N q. ~A C a~3y~
PROPERTY LOCATION: STATE ROAD NAME AND #
The aforementioned site has been evaluated the Harnett County Health Department
Environmental Health Sedon~ At the t1m# of Inspoctibrk there appeared to bar a septic
syffitem serving this Biter. N this system should maftncaon~ the owner Is responsible tot
any necessary repalre..
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 S' FROM ANY PART OF SEPTIC SYSTEM!
00 NOT DRIVE OR PARKOR SEPTIC SYSTEM
TION OF EXISTING SYSTEM
X \11, K.10 2 ~a
Signature of Environmental ea th S no