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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON. NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME D d-!1 ter) M,J,,R-j PHONE # ~ to - - 3,96tt
ADDRESS 9-7 ~ { l7fi c f b br,-"sv; r-i - . -12, -3 `5L'
NAME OF MOBILE HOME PARR OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #5y,1-7 9)1 t f lr ax
5
PURPOSE OF INSPECTION: I;V ~
The aforementioned site has been a aluated byte Harnett oun y HeaCfh 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 for
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
Si afire of Environmental Health Specialist
Date