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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
PHONE # ADDRESS f
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT }222 v r-~,_ ,
PROPERTY LOCATION: STATE ROAD NAME AND # _S n I
PURPOSE OF INSPECTION: D,, ( c
The aforementioned site has been evaluated byte arne oun ea 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 5' FROM ANY PART OF SEPTIC. SYSTEM
DO NOT DRIVE OR PARK OIL SEPTIC SYSTEM
S
Environmental Health Specialist
AUTHORIZATION OF EXISTING SYSTEM
3-(~)
Date