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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME r C) l~ t PHONE #
ADDRESS 1 I ~ 4- ~r~nCt Dr- 4 pe- t'lI (~s C.
NAME OF MOBILE HOME PARK OR S/D L~L,)e-r% Days
NAME OF OWNER (IF DIFFERENT) I 1 (Y-104h
ADDRESS OF OWNER (IF DIFFERENT) I [~Ci IJ n n y~e (
PROPERTY LOCATION: STATE ROAD NAME AND # C a ( Q
Co Et~
PURPOSE OF INSPECTION:
The aforementioned site has been evalua byte arnet ounTfh~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
Signature of Environment Health Specialist
Date