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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #
ADDRESS 3s`tf? /,)c e ,off %V (4 A), C. 775°
NAME OF MOBILE HOME PARK OR S!D
NAME OF OWNER (IFDIFFEREN7).¢ j
ADDRESS OF OWNER (IF DIFFERENI) t/11 tile,
PROPERTY LOCATION: STATE ROAD NAME AND #
PtIRPQSE Q'INSPECTION�
eri� s� ber e�ratuatt a, acne an eatee�tren
env ariri ep a ct�a� t i��� �i�p�ct t r� prp ar .
e se t� ,
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ly
systm sysir s�iauC1q�Ma�irr�ctarl t( {owner ise�anibr` fay
, iyry'' ;'m4`,'Y"'J 5 "`,�.x■y���'�Ciy
+� ki`f,k4F X1Y�YMS�� PEA
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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
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date