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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ( / P~l' PHONE #
ADDRESS 1'(). 13(j`X 11 i C~~ ,c- ,L e _ 2 "715-Zc~
NAME OF MOBILE HOME PARK OR S/D f1 tip,,A-e_,,t.;ect d s 6, A` 3`3-
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7) ~5_ 1-A zk,,J-~ Zi~,541'
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PROPERTY LOCATION: STATE ROAD NAME AND # PURPOSE. OF INSPECTION- if, X'y'. 0_,-J .the aforementioned site has been evaluated yb the Harneaun y ea h 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
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any necessary repairs.
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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 EE ' FROM ANY PARTOE; SEPTIC SYSTEM
DO NOT DRIVE. OR PARK ON SEPTIC SYSTEN .
AUTHORIZATION OF EXISTING SYSTEM
SjgAature of Environmental Health Specialist Date