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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # Sid ,2135
ADDRESS ~-7yj" We dt a J~, (l. Q, 1CLI -f /,/C
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # oZ 10
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health B lom At the time of InspectloN there appeared to be a septle
system serving this sb N thii system should: meAnctlom the owner is responsible for
any necessary repalm
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 5F ROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
2 ci'
ature of Environmental Health Specialist Date