ET RRHTE# 03 ' 1 c l }
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME I =~'fc~ PHONE #
r
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) r`n _ C' (n
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #
The aforementioned site has been evaluated by the Harnett County Health ape rtment
Environmental Health Section. At tM time of In pa
spectfortr there appeared to be a septic
system serving this slta if this system should: matfuncttorr, the owner Is responsible any necessary repalrs foul'
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 0 SEPTIC SYSTEM
DST NOT DRIVE OR PARK ON SEPTIC SYSTEM
l AUTHORIZATION OF EXISTING SYSTEM
J , L 'N
S
of Environmental Health Specialist
~7'"0 Y
Date