ETt a3
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME �- PHONE #
ADDRESS , 1
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER ''
ADDRESSOF OWNER (IF DIFFERENI) "Z7
PROPERTY LOCATION: STATE 1 NAME AND
THIS INSPECTION IS VOID IFa
(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'SYSTEM:
KNOT DRIVE OR PARKON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Si ure of Environmental H alth Specialist Date