ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
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PHONE #
ADDRESS
GX
o n r. 9 3 6
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) S (A^'` N rn <
ADDRESS OF OWNER (IFDIFFERENI) "3 o'D?N o q Dj 0 C-
PROPERTY LOCATION: STATE ROAD NAME AND #f t~ (Z
'ra'. 7 ~/ac z _
PURPOSE OF INSPECTION:
The aforementioned site has been evaluated by t e arne County Health 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
Signature
AUTHORIZATION OF EXISTING SYSTEM
1 9~-0
Environmental Health Specialist
Date
i