ETHTE# _L JD HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME C) (U ` ' ~/1 PHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D Y c A7 O r C icE r~
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 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
Signature
vironmental Health Specialist
Date
BUILDING MUST BE 5' FROM ANY PART OF. SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
ANUTHORIZATION OF EXISTING SYSTEM