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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEP'T'IC SYSTEM INSPECTION
NAME PHONE # 0 ~ C: - 3,? Us 8
ADDRESS i ~ ~c C t i} `~T >E r`D~ ;5 -v R- Lv ty ' 35
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #i
PURPOSE OF. INSPECTION:. .,iff
The aforementioned site has been evaluated by trneoun y ea 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'5s FROM ANY PART; OF SEPTIC SYSTEM
DO. NOT DRIVE OR PARK ON SEPTIC SYSTEM -
AUTHORIZATION OF EXISTING SYSTEM
ture of Environmental Health Specialist
(1-12-
Date