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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME JrJJ~ ~ &/41- ✓.-t'e,-,f jj5 PHONE #
ADDRESS C
NAME OF MOBILE HOME PARK OR S/D j L r 7~' ( l
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # C
t7~= C
PURPOSE OF INSPECTION: " i/ 13
The aforementioned site has been evaluated by the Harnett County ReaTth Department
Environmental Health Section. At the time of inspection, there' appeared to be a septic
system serving this site. If this system should malfunction, the owner is responsible fore''
any necessary repairs:
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 SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
~a
Date
Si ature of Environmental Health Specialist