ETHTEO~ 1-S ~q 7 U
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME SEG Pti PHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #"T
S~cd 13Lr C "-L5
The aforementioned site has been evaluated by, the Harnett County Health De'
Environmental Health Section. At the time of In partment ;
si~bm there appeared to a sepft I
;
system serving thi t site, If thle system should`maifunctioM 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 MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
QG NOT DRIVE OR PARK OR SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
&S
Signature of Environmental h Specialist