ET RHTE# —S 33°735/2
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME S S In O* 1 ,PHONE # T15— 'es-66Z7
ADDRESS e., lLl' ® �. NvC„ ?115` 6
NAME OF MOBILE HOME PARK OR S/D 6 q��r�► rte,
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # %
PURPOS O INSPECTIONS Zz )OP_rt. ��-
x s.. a ,.�
`irks "tut . b t a aIt rya [UN# 1
'z?, y;� a�w `w'aui'wL '�s aj C
Sri n�i f Cpltt��h i�[ 11a1` to "a se t� w
a w:,tw t'wt .tS ..W, ud ,?r-�ri'`%ti t L ,�1aa Kz"i+ \;k 4, , <"; '�"�'.t iu�` " ',: A t .;�: p,.r
Systern� s� v� g ti si p [fjnit sy stern;; ou[c r a� i r �t ate [� cu ner`is res an a
Y t s[be fog
R "t' y�{a/s ,
3 � u w ��,�m '�"` , `�v'�".'ni ', ,i \1.0 ., . �„ ,a, �, n'�ryP, � }, . µ. 'u t s • krx
v ,a
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
Signs ure of Environmental
Specialist
Date