ETHTE# :c:6 ~ L
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON. NC 27546
EXISTING SEP'T'IC SYSTEM INSPECTION
NAME
ADDRESS
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NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
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PROPERTY LOCATION: STATE ROAD NAME AND
PURPOSE OF INSPECTION: Z~Q 5
The aforementioned site has been evaluated byte acne county-H-e-affh 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
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PHONE # ~ - Z5z5 r
ture of Environmental Health Specialist Date