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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME S
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PHONE # V`t -'iZZ -
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ADDRESS 3~t_3
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NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) (~~*r~v, L Cry
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ADDRESS OF OWNER (IF DIFFERENT) / 32
PROPERTY LOCATION: STATE ROAD NAME AND #a"L-
PURPOSE OF INSPECTION: _ ~~s 5 1,
The aforementioned site has been evaluateMy e ar 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
AUTHORIZATION OF EXISTING SYSTEM
of Environmental flealth Specialist
3-1-7 -tI
Date