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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #
ADDRESS 1 `--11 V, c ~ ' Y-( f (a -tom'; 0(-
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # \
The aforementioned site has been ovatuated 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 maifunctlorr, the owner Is responsible fore
any necessary repalr&
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 SYSTEI%
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of
tA-
Date
D
32
Health Specialist