ETHTE# l '— , -
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME !�' ���� , <..: ®r�- ' . s PHONE #
ADDRESS '� 1 ra` 0 r•- .J s ' 0 c ' �a p w �� r
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) l
ADDRESS OF OWNER (IF DIFFERENT) (l� J /> ?
PROPERTY LOCATION: STATE ROAD NAME AND #
PU,RI'OS Q 'INSPE TIO�V , Z - r !
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
BUILDINGAUST BE 5" FROM ANY PART'OF SEPTIC'SYSTEM,
DONOT DRIVE OR PARK ON SEPTIC SYSTE