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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 6 PHONE # 740 71` e ; ;-vv
ADDRESS f o a l 2
NAME OF MOBILE HOME PARK OR S/D IV. V
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
-7 A
PROPERTY LOCATION: STATE ROAD NAME AND
PURPOSE OE INSPECTIONv Y 1;
The ai`orementioried site ":has been evaluat86y.the~farnel oun y earth department
Environmental Health SeationyAtth"e'time, of inspectl6n, tflere'appeared to tie a septic,.=J
system serving this site If this system should malfuncti6n,' fie ow ner is responsible for
~ealrs
necessary
Frd .ny
e r;~.."'',~4F'a'"e'a^n~~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
:e e+. ~_,~r .c~ti~at 'r ~,y-~ei,~3+'c -n. ,t ,gn,',c~ ;~`~-'_°~s,re'fi' -;mss ~~{x~ *;,dt~..x.,-o-`x. ~ •5-•_.-,~,.:..,SX~-k ;...;:.t.,. ,.._Pa 3.jn
BUILDING MUST BE-5' FROM ANY PART OF. SERTIO SYSTEM
c r e
QO.NOT,,DRIVE.Ofd PARK ORSEPTIO~:SYSTEt~ ~ gr
AUTHORIZATION OF EXISTING SYSTEM
re of Environmental Health Specialist Date