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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME, PHONE # `jll3-10o,
ADDRESS a 5L-vS (')c tom, . ~ 9, ~ L
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # C,- n-a -W~ 3
The aforementioned site has been evaluated by the Harnett County Health Department,`
Environmental Health Section. At the time 6f inspection, there appeared tv boa septic
system serving thid site. If this systertt shouldmalfUndlbm the owner ie responsible ford
any neeessa4 repairs. r
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 SEPTIC SYSTEf
DO NOT DRIVE OR PARIS ON SEPTIC SYSTEX
UTHORIZATION OF EXISTING SYSTEM
Signature of Environmental
Specialist
~~i~/a
Date