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HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME - 7j 3 PHONE # W 5 •,6 3i o �zs
ADDRESS
NAME OF MOBILE HOME PARK OR S/D tA-)06-Ca-0 e&4-j'Y—
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # {Qua b-yO iE �
PURPOSE OFINSPECTION
:
The aforementioned site has been evaluated byte Harnett County Health De artment
Environmental Health Section. At the time of inspection, there, appeared to be aseptic,
system serving thli site. If this system should malfunction, the' owner is responsible for
any necessary repalrs
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 ON SEPTIC SYSTEM
AUTHORIZATION
SYSTEM
of Environmental 13ealth Specialist Date