ETHTE# - _
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~ PHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT) ?if 2
PROPERTY LOCATION: STATE ROAD NAME AND # L✓~~z~~, ,>r"~
PURPOSE OF, INSPECTION, JZ~' a ( r?~ f }
The aforementioned.site has been evafuatedytFie~Harneaun yHea]Ih Department {
Environmental Health Section: Af th`e time of;inspedon, there appeared ta, be a septic j
systemserving this site; If this,systern should. inalfurictfon,'the owner Is responsible fore;
r
~yany ~iecesary repa
`v ~t^._-.
w
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;NIUST. BE 5". FROM ANr PART OF SEPTIC SYSTEM
r tt DOtQ` DRIVE OR PARK ON SEPTIC SYSTEM.
T x,Y~
AUTHORIZATION OF EXISTING SYSTEM
of Environm6ntal Health Specialist
Date