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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /CP.ckj. 4 ?oa/ PHONE # 9 o - $7 - ZSlZ
ADDRESS E-0-2a 336 42- 4 ,E,Cc „ iU. C- 26376,
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) L
ADDRESS OF OWNER (IF DIFFERENT) /S3
PROPERTY LOCATION: STATE ROAD NAME AND # ftfz,1 S
PURPOSE OF INSPECTION: .
The aforementioned site has been edaluated by the Harnett oun y eta th 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
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of Environmental Health Specialist
Date