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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME C: PHONE #
~1 `i - t 3 9- fi(,~ l
ADDRESS L 4,115
NAME OF MOBILE HOME PARK OR S/D~.
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND
The aforementioned site has been evaluated by the Harnett County Health Department;
Environmental Health Section; At the time of inspoctlorrv,- there appeared to be a septid.
system serving this situ if thle system should: manmctlor4 the owner is responsible ford
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 MUSS` BE 5' FROM ANY PART OF SEPTIC SYSTE14
DO NOT DRIVE OR PARIS ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Al 4 .1 %047
Date