ET RHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 7:1 1 ~
ADDRESS I< 1f; i~J -~r" (
NAME OF MOBILE HOME PARK OR S/D'
NAME OF OWNER (IF DIFFERENT){~(~
ADDRESS OF OWNER (IFDIFFERENT) dit-
PROPERTY LOCATION: STATE ROAD NAME AND # PURPOSE. O E, INSPECTION-
Ti he aforementioned site bias been .evaluated by»the me ^ ou-may FfeaTth Department
Environmental Health Section`At thetime of-inspectlon, there appeared to be aseptic
system servinig this _siteJf this-'s ystem should malfunction," the owner is responsible f6r>1
k.. t n
r r,
f 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 ANYPARTOE SEPTIC SYSTEM s
D® NOT DRIVE OR PAREC QN SEPTIG SYSTEM,
'.'~y."-g.,,
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date