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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
NAME l7v~p~y
ADDRESS ?.o.
EXISTING SEPTIC SYSTEM INSPECTION
'~N N• C .
PHONE # ll a,0 `Z SI2 3
S"
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 evaluatedby" the Harneft County Health Dertmerg
Environmental Health Section, At the VIM of lnspectlow, there appeared to to a
syst0m serving thill situ If this system should maltunctl'or% the owner is responsibsopfft
le fore=
any necessary repairs*
~r
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 SYSTEIW
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist ?
Date