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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME fy C-. PHONE # 91g7~y y x-
ADDRESS /r-2 a;iyt„t. CcIAJ Air. I
NAME OF MOBILE HOME PARK OR S/D = ~ ~►e.- C jr E X2,4
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # / S`6
The aforementloned site has been evaluated by the Hamett County Health Department
EmelronmentW Health Se am At tha tfm* of Insp IoM thers appeared to ba a septla
system serving thlit site, Nthle system should malfunction; the owner Is responsible fort
any necessary repalr.,
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 MIST BE T FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
412-11e~
Date