ETHTE# 4 Y
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
PHONE #
ADDRESS ~NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) /v l;
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE OF INSPECTION: , M. t .r -i6 t c' "t ~
The aforementioned site has been evaluated by the Ra-r-n-eff-C-6-u-n1y-He-a-ffh 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
Specialist
s l ~
r K- ~
ignature of Environ
Date