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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME '
fz~ PHONE # `1 2 7 3
ADDRESS 44c5'
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # /k-L,4 S~
r
PURPOSE. QF, INSPECTIO_N: ll °I
The aforementioned site has been evaluated he F rnet~aun- FTeaTth ®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 repa~rs
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 PARS 4F SEPTIC SYSTEM
Da NOT DRIVE OR PARK,ON.SEP!IG_ SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
/lt)&~
of Environmental
9 - 7!, /i
ealth Specialist
Date