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HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ` I..) n)e -3 PHONE #
ADDRESS 33 �
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # Z21 5'
PURP ®SE OF'INSPECTION
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Entirnce tai . , lira A�h� ns ct�a t9 a �{ardc a ae ,:�
gw 'n system senrsng t IRE r t i sxs #arr s�iout mia� ut�dt ar th ��wnar is e$p�na�b�i for,
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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
BUI.�IN MUSS` E 5 FROM ANY PART O SEPT[ C SYSTM
DO" NOT DRIVE OR PARK ON SEPTIC SYSTEM