ETHTE# 01- 5-1 / 'C
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME k L , C;~ >~,L PHONE #
ADDRESS A1c IC ~r
NAME OF MOBILE HOME PARK OR S/D Q,,~-f I
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND
The aforementioned site has been evaluated by the Harnett 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 MUSS' BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of
Health Specialist
Date