ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~ t~ ~ ~ ~ 'VA
PHONE # ADDRESS
NAME OF MOBILE HOME PARK OR S/D m.~ . "
NAME OF OWNER (IFDIFFERENT)~
ADDRESS OF OWNER IFDIFFEREN ~Gr:til
PROPERTY LOCATION: STATE ROAD NAME AND PURPOSE OF INSPECTION:
The aforementioned site has been evaluated by the Na-r-n-effC6-u-nTy-H-ea1ffi 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 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Sign-'ture of Envitd'nrdental Health Specialist
Date
~Z'