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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 1,, L,~}1,
ADDRESS 1l J Qn, ~(u
L
PHONE # NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) SQL
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # --1 C G~~ ~l
The aforementioned site has been evaluated by the Harnett Count Health Environmental Health Son. At th# time of Ins9ecdoM Department,
$tstet t there appeared to be a septic l:
senrlr~ #hie sit N this system should malfunctior4 the owner is responsible fore
any necessary repair„
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 MUS1 BE 5' FROM ANY PART OF SEPTIC SYSTEM
DG NOT
DRIVE QR PARIS ON SEPTIC SYSTEM
-
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
S
D?
J
Date