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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME C L)Q--TiS '0• C-O Li ~GiL PHONE #
ADDRESS ~ LA L ocxLSi, 'Oa. L. a6+v ~1 C. 2.X35 ~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) _
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # L uc
The aforementioned site teas been evaluated by the Harnett County Health Department
Environmental Health Section: At th'time of inspectlok there appeared to be a septic:,
;
system serving this situ. If this system should' malfunctiony the owner is responsible fog
any necessary repay.
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' FROUANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
UTHORIZATION OF EXISTING SYSTEM
,~-5
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Signature of
alist