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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEAL'T'H
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEP'T'IC SYSTEM INSPECTION
NAME PHONE # >f ` t
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ADDRESS ZL(Z?~er~~~ l~iC Jli' 7
NAME OF MOBILE HOME PARK OR S/D L,,-4 i3
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFI)IFFERENT) /Ij k' . 27
PROPERTY LOCATION: STATE ROAD NAME AND # L J ttb
PURPOSE OF INSPECTION:
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The aforementioned site has been evaluated by th-ern6tt oun y ea Depnt
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.
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THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or j
(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 DE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date