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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # ~ 0-1 ADDRESS 0 rD3~ C3v ~NLC~~L NL as
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFERENI)
PROPERTY LOCATION: STATE ROAD NAME AND # l 1 P.a VoQ62-' 5 'Q-O
The aforementioned site has beep evaluated by the Harnett County Health Department,
Environmental Health SectforY At the time of inspection there appeared to be a septic
system serving this situ. Iftfil system shouldmaffilnctfon, the owner Is responsible foal-
any necessary repair:
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 PARS' OF SEPTIC SYSTE14
DO NOT DRIVE OR PARIS ON SEPTIC SYSTEM'
i\
UTHORIZATION OF EXISTING SYSTEM
Signature of Environmental H
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