ETHTE# 14-5-
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME �A --j %� PHONE # 9r5 - °� ?
ADDRESS Ci r= �tr2.a— r°` f V, r
NAME OF MOBILE HOME PARK OR S/D 4) 1 Aa '-'S 4r c i-/ a z
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # '25t./Y36 c-Z— X45
,PURPOSE UFINSPECTION
T'a''-e OF a 4a y
}..e r}�r (+ ay'jj ep�#nen g
i. n�4� �r �1�a is ��. `ri� `,+��' v"'' Nyk
,. a,,'Kx s.�} "inti� ti►MyyCt o tl a ear+ use y7�'
vY.. t?..a„1 *a o,a 2;,,`11r,'m� 1sS,,t� �1F. ,.,�i
sy$ }� e s cving `f i�� � �� t t,l syste s io�u[ �r Mf � �3own is spon
#,�'il��" 0� t�,
�,�#n,r,��� d�,,�y°M�;�a �� %�,a ty1��u � ;;�� u :' „Q� �ri►G� � , �G a���i, x' Y� F,�„��y�nii��a� � �. , �m� #�”' tai r�" +�w 4� o
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
Health Specialist
Date