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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME f"~ a>;- %~'~,~~;,~r`~'• PHONE # 7~"7-V")-7 3
ADDRESS
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NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) &;j-z;<
ADDRESS OF OWNER (IF DIFFERENT) 6, 1 1
1a~~ 14WIP A
PROPERTY LOCATION: STATE ROAD NAME AND #
P~U"_OSE_, OF, INSPECTION
The aforementioned site has been evaluated byte acne ou--nlyFlea7fh 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 A,NYPA(T OFSEPTIC SYSTEM!
DO. OT DRIVE OR PART( WSEPTI,G SYSTEM
Si
AUTHORIZATION OF EXISTING SYSTEM
re of Environmental Health Specialist
J _
Date