ETHTE# I L -5-- 7 5-7
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # X12 ,J
PURPOSE OF INSPECTION; I q ~ -
The aforementioned site has been eva uat by the arse County7 H#alth Department a
Environmental Health Section.Ott the time of Inspectioftj there appeared to be a septic
system serving thit situ If this system should, malfunction the owner Is responsible for
any necessary repalm
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 SEPTIC SYSTEM
DO NOT DRIVE OR PARK 014 SEPTIC SYSTEM.
AUTHORIZATION OF EXISTING SYSTEM
Si ature of Environments Health Specialist Date