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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # ADDRESS A)• C 5~Z r, t - Ai ~ - 77,;- 7~,.
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # I Y6 7
_ _ , _ - .
. PLZRPOSE.OFINSPECTION; , l' Y 1
The aforementioned,site f as been evaluated byte Harne~ounty liea~fh Department:
Environmental Health Section: At the time. of'inspect on, there appeared to e -a septic `1
system serving this. site If this system should malfunction, the owner. is responsible for 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
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BUILDING MUST UE 5' FRONT ANY'PAR.T OF. SEPTIC SYSTEM
QQ` NOT, DRIVE OR PAR~C ON SEPTIC,S~'STER
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AUTHORIZATION OF EXISTING SYSTEM
ature of Environmental Health Specialist Date