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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~ k-G C Icy( S~z: vst~ PHONE # (t l - ?173
ADDRESS
NAME OF MOBILE HOME PARK OR S/D U', (k , L-, t 4
NAME OF OWNER (IF DIFFEREN7) 6„-.44t 6$ ,
ADDRESS OF OWNER (IF DIFFERENT) `77 q Ste..- V C a.
PROPERTY LOCATION: STATE ROAD NAME AND # 2 a C` Jc, U-P
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' 'TbM
DO NOT DRIVE OR PARK ON SEPTIC $YSTEM
AUTHORIZATION OF EXISTING SYSTEM
ature of Environmental Health Specialist
17 /2
Date