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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # ADDRESS fZb I/ : INJ
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) J -
ADDRESS OF OWNER (IFDIFFERENT) /36c-~-- tj,C • -f-2- t1a6-~15a=cam 775-Ye
PROPERTY LOCATION: STATE ROAD NAME AND # / z-
PURPOSE OF INSPECTION:' (gJ_~,~
z ray ~ The aforementioned site has been evaluated by the Harnett oun y Health 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 DUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
ure of Environmental Health Specialist
7-S i(
Date