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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME -1PcL~L, c'c ti~ t ~c~ PHONE # (5Z-9t o5
ADDRESS 1'9-l0 1~on~ES~oE BF.f„ow~~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) SNm, -
ADDRESS OF OWNER (IFDIFFEREN7) a`~a5 ~►nc~s I~ ~L'Q9
PROPERTY LOCATION: STATE ROAD NAME AND #
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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, Ifthis system should malfunction, the owner Is responsible forI
any necessary repairer.
a
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
~UUTHORIZATION OF EXISTING SYSTEM
Signature of Environmental
Specialist