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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27545
EXISTING SEPTIC SYSTEM INSPECTION
NAMES-; PHONE # it - 'l- yg~
ADDRESS e~ 9 A-~ - C 2"2S' 1 ~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) Zee- &C -w 5,-,~ j2() f L~ C - 2 Zw
PROPERTY LOCATION: STATE ROAD NAME AND # Atze
PURPOSE OF INSPECTION: 4te ~ The aforementioned site has been evaluated by Herne County ea fh 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 Y FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Si ature of Environmental Hea th Specialist Date