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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
n EXISTING SEPTIC SYSTEM INSPECTION
NAME
PHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D 74, J U Mr., , ~ 5 S
NAME OF OWNER (IFDIFFERENT) o ~ _ ~ f~, 6
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ADDRESS OF OWNER (IFDIFFERENT) )0,z fig NL
PROPERTY LOCATION: STATE ROAD NAME AND # ) I I )
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If this system should malfunction, 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 Y FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature f Environmental Health Specialist e
Date