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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME f f~~~~~ } PHONE #
ADDRESS Q. D
dDx 533D-?
. rig? 3~
NAME OF MOBILE HOME PARK OR S/D P-1- 1(-1h "t + 11-
NAME OF OWNER (IFDIFFEREN7) lkrs
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # E-{2 i
The aforementioned site has. been evaluated by the Harnett County Health Department, y
Environmental Health Section''. At the time of inspectlorr, there appeared to b4 ii septic, . :
system serving thin situ If thls system should maffunctfort, the owner Is responsible for4,
any necessary repalrs.
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 Y FROM ANY PARS` OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
~a -)o- 0-~
Date