ETHTE# o F - s' i to
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
PHONE #
ADDRESS f
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
The aforementioned site has been evaluated by the Harriett Coup Heal
Environmental Health Section. At the time of inspeWork ~ th Department .
system serving this alt~►; K tltl~t system should malf ort~the opt aced to be a septic
r s responsible fore1
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 5' FROM ANY PART OF SEPTIC SYSTE
0 NOT DRIVE OR PARK CAN SEPTIC 06TEM 3.
UTION OF EXISTING SYSTEM
ature'of Envio
r nienta1
! lis'/zc,c 1.
Date
Specialist