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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME — t e PHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D /La--ierti
NAME OF OWNER (IF DIFFERENT) S --
ADDRESS OF OWNER (IF DIFFERENT) 5c�—
PROPERTY LOCATION: STATE ROAD NAME AND #0'�r (1 �iL' 4., -
PURPOSE
PURPOSE OF INSPECTION. "'Y �_���
y ea
The aforementioned site has been evaluated t e arnett Coun 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 f
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM�
AUTHORIZATION OF EXISTING SYSTEM
of Environmental hdalfh Specialist Date