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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # /0 7-7966
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #,af Z~cQ~
The aforementioned site has been evacuated the Harnett County Health Department
E61tonmenfat Health Sectiom At the time of Inspectlon, there appeared td bo`s septic
system sensing thin sits If this system *W( malfunction, th'
Or wn
o ' at Is responsible for j.
any necessary repairs. ; t
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 PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
r
AUTHORIZATION OF EXISTING SYSTEM
C C~ (~n✓~~rvt - / - F5-0
of Environmental Health Specialist Date