ETHTE# ,
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
z ` = y a
NAME PHONE #
ADDRESS NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # PURPOSE OF INSPECTION--
--The aforementioned site has been evaluated byte arne oun y eaffh 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! j
DO NOT DRIVE OR PARK ON SEPTIC. SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date