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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME � , � o-✓► W{� ,i &115 PHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D ii
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # �5 y
PURPOSE OF INSPECTION:
' The aforementioned site has been evaluat byte arne oun y H 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 repa!rs
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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 ,i
DO NOT DRIVE OR PARK ON S015TIC SYSTEM d
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s AUTHORIZATItON OF EXISTING SYSTEM(/
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° Signfiture of Environmental Health Specialist Date