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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
NAME
ADDRESS
EXISTING SEPTIC SYSTEM INSPECTION
3 y ---JD ~N r". r. PHONE # s--
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # - (-IK
The aforementioned site has been evaluated by the Harnett Counter Health Department
environmental Health Section. At the tune of lnspecdoM there appeared to boa septic
system serving this site. If this system should mahnct[oM 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 MUSS' 'FROM ANY PART OF SEPTIC SYSTEM
00 NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
ature of Environmental Health Specialist
Date