ET:
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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27545
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #
ADDRESS
NAME OF MOBILE HOME PARR OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFEREiY7)
PROPERTY LOCATION: STATE ROAD NAME AND # PURPOSE OF INSPECTION: The aforementioned site has been evaluated by th-eTFa-r-ne-ff-C`6-u-nFy-FFe-affh 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
D® NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
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Signature of environmental Health Specialist Date