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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME J' el
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
"7 5.2 Co
PROPERTY LOCATION: STATE ROAD NAME AND # Sit IVI;~
The aforementioned site hail Been evaluated: by the HArnett County. Health Departmena
Environment F#eatlt SBCtIon: Atthe Vino of lnspeEtl04 there
system senrfng thlal site. ff tall system should tepea:
malhlrratton~ the owner is freto' e ~ sibls to
and necessary repalca:.i
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 fix' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
PHONE #45-s 2-4279
Of EOvironmental Health Specialist
Date