ETHTE #) It
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME + P6.1 ® G PRONE # -
ADDRESS L7&0
NAME OF MOBILE HOME PARK OR S/D i
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE OFINS�CPECTION� ' 7
Rgri TC fa�cies�h Sr e�r�ua� arna oun "a D�men ir �nr�nrnea RroA�� �Inses±f tr�a[(Jsred t a sapf�
i �, �� Y
system �etrin fii titi ssr sfiaut "ralfuict�vnar is`esp�onsib��e fog
.'�SiA�.a.ax „" „tw.5 y.er �3 ,fir r / 4 i "''KY`+�*g' 4 .,- �lty Ms`. .`f"'.,.� ;
'' .c^reas.*n*?.' tE.
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or
(Z) 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 BB S" FROM AN1f PART O SEPTIC SYSTEM
6 NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date