ET RHARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ` ` i.c t-� 2 PONE # la p
z3
ADDRESS
NAME OF MOBILE HOME PARK OR SAD 0 6'6Ly / D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # Z!
PURPOSE Ole INSPEC?'ION:._
Tie afo6 enftc a sff� h 9 06. @Yalua f arrte ai111 as Da a enf r
�t1y1r. h- rnen a ��t s Gfr��A �t s 4 � . ,
X11, p cf o ; fftar x
stew serving' steR tth�s 4 s s
ppeared ter+ seprt�
v �rr��`si�aut ri�arfurirtiAn.: f�,�►���.;.,� ��: �__._��..�� �_ ��
+?s
r w Y
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