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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME &A-UP~$ (~~:t t ate., PHONE # ADDRESS ?0 (3a;,, ljgZ,6' L am" X)" -Z7~5
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREA'7)
ADDRESS OF OWNER (IF DIFFERENT) 79`7)- 1-,V; /v".c 7757(
PROPERTY LOCATION: STATE ROAD NAME AND
PURPOSE OF INSPECTION: f -r..~ &4, '
The aforementioned site has been evaluated byte arne County ea epartment
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 DUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF XISTING SYSTEM
S4n,6/ture of Environmental Health Specialist
, ~i=l
Date