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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME A { h <e rt 2 PHONE # 3 s- 3 - Y`f Y/
ADDRESS 9'D
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NAME OF MOBILE HOME PARK OR S/D k~ ` ter- b f 2
NAME OF OWNER (IFDIFFEREN7) S CN-~
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
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PURPOSE OFEVSPECTION:
The aforementioned site has been evaluat y t e arne oun 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 4
DO NO }RIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
I A
of Environmental Health Specialist
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Date