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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # - L//Z - 7z
ADDRESS Z r
NAME OF MOBILE HOME PARK OR S/D (4,-; re4~ ,Js t- ~7
NAME OF OWNER (IFDIFFEREV7)
ADDRESS OF OWNER (IFDIFFEREti7)
PROPERTY LOCATION: STATE ROAD NAME AND # Zoo rye,) p PZ a
6 zx/3~ lr~~
PURPOSE OFINSPECTION: ~t~' M
The aforementioned site has been evaluatd e a` n oun y eaTfh 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
AUTHORIZATI
Siu ature of Environmen
1 OF EXISTING SYSTEM
2-jo-f I
Health Specialist
Date