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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # ?i-7 - l 7~'- 317.rO
ADDRESS 30o kr,,~„~rc 4&,Cek Dot
NAME OF MOBILE HOME PARK OR S/D Gce*-&
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # -5W / 4/ yp
The aforementioned site has been evaluated by the Harnett County Health QepaErtment
Environments! Health Sodom At the time of Inspectiom there appeared to be a septic
system sorvIng this site. If this system should ma rtct1*M the owner is responsible for,"
any necessary repalrs.
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 $E,TIC SYSTEM
Dt NOT DRIVE OR PARK CAN SEPTIC $YSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
3-11-0
Date