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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME� . 91,4'le1 PHONE #
ADDRESS /z� 4'/ !PYIL Fci✓« t llle z
NAME OF MOBILE HOME PARK OR S/D A,(a)h,//v► �-
NAME OF OWNER (IF DIFFERENT) ArAg-
ADDRESS OF OWNER (IF DIFFERENT) S
PROPERTY LOCATION: STATE ROAD NAME AND #
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'PURPOSE OFINSPECTION � ���,.r
The aforementioned site has been evaluated by Aiarn—ett CdMfoialth Department 31
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
BU GING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM.-,} ' s
DO<NOT DRIVE OR PARK ON SEPTIC SYSTEM : y
AUTHORIZATION OF EXISTING SYSTEM
Y
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S a re of EnWonnkuW Health Specialist Date '
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