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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Co 2 ,N R"I /I i t V. PHONE #
ADDRESS ,1 7 0Q'1 ~ 1 c~ c~~~ A ~l~• „r
NAME OF MOBILE HOME PARK OR S/D " -
NAME OF OWNER (IF DIFFERENT) -.C~f k A-
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #
~l1 (r
Ths a#orerhenned slit has been evaluated the Narnet Count Health Department
Environmenfal Health Section. At the time of inspection, titerrr appeared to be aseptic
system serving thli9iw, if thfe system should malfunction, thO owner is responslbis for
any necessary repairs.. F
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 Y FROM ANY PARS` OF SEPTIC SYSTEIIN
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
S
Environmental Health Specialist
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Date