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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
PHONE # ;
NAME
ADDRESS 10"--
N qY
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)' 3 a€ ~ADDRESS OF OWNER (IFDIFFEREN7)>bn E Eu
PROPERTY LOCATION: STATE ROAD NAME AND r
PURPOSE OF INSPECTION.
The aforementioned site .has been evaluated by t e. `arne County Heaffh, Department
Environmental ,Health Section. At the time of inspect 16n, there appeared to bea septic
'w
system serving this site. If this system should malfunction, the owner, is responsible for
any, pecessery 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 BEj5' FROM ANY PART OF SEPTIC SYSTEM f
-D0 NOT DRIVE OR PARK ON.SEPTIG SYSTEM:
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date