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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ovPPHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) Cr~vcw ~tioo NC-E~L
ADDRESS OF OWNER (IFDIFFEREN7) LP'Y-L
PROPERTY LOCATION: STATE ROAD NAME AND # L S~
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Sectlon At the time of inspection, there appeared to be a septic
system'serving this site, If this system should malfunctlorN 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 SEPTOSYSTEM_
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
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[ZATION OF EXISTING SYSTEM
Signature of Environmental Health
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