ETHTE #: 16 -S - SWt (3
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name:ltne5)-T-/ Phone#:1tG-4M-31a3
Row; I-11eiL
Address: -TW
Name of Mobile Home Park or S/D: 1 iN Q 6.N Qo, N; C- 1 srt X7.6
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #):
Purpose of Inspection: Sy6,D
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If the 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 change, 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 OF EXISTING SYSTEM
Signature of Environmental He Specialist