ETHTE# - ,6~ I 3 S
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME c( A(' t>, j
PHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D LJC*d T
NAME OF OWNER (IF DIFFERENT) r
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # C o? ~f d
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. fo
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 S= FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK OIL SEPTIC SYSTEM- M
AUTHORIZATION OF EXISTING SYSTEM
Signature f Environmental Health Specialist
Date