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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
ADDRESS '576
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Health Specialist
NAME OF MOBILE HOME PARK OR S/D llu 7yv{ , Lo I
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7) S
PROPERTY LOCATION: STATE ROAD NAME AND # U--tW,11- LP, Ix, "
The aforementioned site has been evaluated by, the Harnett County Health Department
Environmental Health Section, At the time of th#pk- om there appeared to be a septic
system serving thi# site. If this hem should maifunction4 the owner is responsible fore,
any necessary repalm I:
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 Sk' c1} sl°
(3) the owner or tenant of the property changes, and/or Ark
(4) after six months s'v-f < S
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
00 NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of
PHONE # VS & 3"-(-)(
Date