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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 611'"7- - c~
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ADDRESS /0 C 2.7 45-9
NAME OF MOBILE HOME PART{ OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND
PURPOSE OF INSPECTION: 5 ; ~ s
The aforementioned site has been evaluated byte arne oun y 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 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
jz -7 jL)
ature of Environmental Health Specialist Date