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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~j ~l T/1 &Ouja
ADDRESS ~~OV ~~2cvQf--~ J-) h U~
NAME OF MOBILE HOME PARK OR S/D
PHONE # W - Ca 9-- 7146
pec
NAME OF OWNER (IFDIFFEREN7) Aall Q EMS huLcl::~)
ADDRESS OF OWNER (IFDIFFERENT) C p -CL/11-6 7P11
PROPERTY LOCATION: STATE ROAD NAME AND # A)~((-Och (1 (A/
PURPOSE OF INSPECTION: f l ' V"z
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The aforementioned site has been evaluated by the arne oun v ea enartmant
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
DG NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXIS
S
6lr
of Environmental Health Specialist
G SYSTEM
Date