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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #
ADDRESS 21Y C C.
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE Q. INSPEC2'IQN. k
totefpiennt� f4stt 11 be rt evatuat rn oun r d
0 b t; a ea De men y.�
Env Conn e�nt �n p�+Et o t l pip tired i ept�c
system sinrin� thl si � it"t i s m S ,QUl "n ialtundly -h tf a awnar is es�an�i fa '
Nil IN,
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~MUS B 5' FRO ANY P RT� SEPTt C SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM—
AUTHORIZATION
of Environmental Health Specialist