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~.HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEP'T'IC SYSTEM INSPECTION
NAME, c.csPHONE # 5 l i~2 3, 11
ADDRESS :2 11 =?Q,"u 2~'~ 4 ~ ~c-ti Z.~~ %
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFEREA'7)
ADDRESS OF OWNER (IF DIFFERENT)~
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PROPERTY LOCATION: STATE ROAD NAME AND #6-),L 15'-I C
PURPOSE OF INSPECTION: -~3 0 `
The aforementioned site has been evaluated y t e arnett Coun y Health 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 Health Specialist Date