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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Leo „ GQ,EEN - C-- - PHONE # 4,1,1
ADDRESS 300 G ►~sc S T y C~Ev.Lt E
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) 1-r -
ADDRESS OF OWNER (IFDIFFERENT) L- O Q,1NG LAC. njG a~310
PROPERTY LOCATION: STATE ROAD NAME AND
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. 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
DO-NOT. DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmental
Specialist
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