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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS'T'ING SEP'T'IC SYSTEM INSPECTION
NAME _z sh /e,, PHONE S `~j 7 ,?4>
ADDRESS I~ Lc G k~ ~t; ,Er ' ~ L~ - ~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) ADDRESS OF OWNER (IF DIFFERENT) ' Ije5 /3,Q f ,f ` Z
PROPERTY LOCATION: STATE ROAD NAME AND # /7Z& /T~k,6j
cry
PURPOSE O INSPECTION, r'c-C , I,r} j x
The aforementioned site'has been valuated y t e arnet~.~oun~y ea h~7epartment
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
BUILDINGMUST BE 5 FR0M.'ANY PART OF SEPTIC S
YSTEIVI
DO NOT DRIVE OIL PARS QN SEPTlG SYSTEIy
AUTHORIZATION OF EXISTING SYSTEM
of Environmental
ealth Specialist
91ab
Date