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HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME '
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PHONE# 91%—J3F,0-9"
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PROPERTY LOCATION: STATE ROAD NAME AND #za-a3Z AtgQ4�
PURPOSE OF INSPECTION: LN is 4i y
The aforementioned site has been evaluate by t e. arne n y ea Department
Environmental Health Section. At the time of inspection, thereappeared to be a septic
system serving thlisite. 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
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of EnvirondientaT Health Specialist Date