ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #~S~ SS 15
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7) 43 C,fj~'Ae Sewn` UL ~~3~~
PROPERTY LOCATION: STATE ROAD NAME AND #
S Y5 CE.,,r, l5 t~E1NG ' IP1..rCQ~N f~ ~G~ v
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Sectlorr. At th* fine of inspectfon4 there appeared to ba a septic
system serving this sit*. K this system should malfunction the owner is responsible for'll
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 DUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
00 NOT DRIVE OR PARK ON SEPTIC SYSTEM[
TION OF EXISTING SYSTEM
Signature of Environmental Health
Date