ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # i - 6)~2
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ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
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PURPOSE OF INSPECTION:
The aforementioned site has been evaluated y t e arne oun y earth Department
Environmental Health Section. At the time of inspection, there appeared to be a septio
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 DE 5' FROM ANY'PARTOF SEPTIC SYSTEM .
t Y DO NOT DRIVE OIL PARK ON SEPTIC SYSTEM" 1
AUTHORIZATION OF EXISTING SYSTEM
ature of Environmental Health Specialist Date