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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ' X09 A' 0/? j PHONE # ?C -(64/ - 53'79
ADDRESS //1900 /v 2,c /I S,5- 4) , '.4,Zu /N'L. Z7,<-/.�
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # z.
PURPOSE OF INSPECTION: �-
The aforementioned site has been LN. byte ain,1:1YC00—nTy-H-e-aM 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
of Environmental Health Specialist Date