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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 257- 4, 25
ADDRESS � vel ,b A✓d4 v. c, 2-&5591
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)1>oN�� t 13ab61 e ?4�,4
ADDRESS OF OWNER (IFDIFFERENT) k70✓
PROPERTY LOCATION: STATE ROAD NAME AND # 34-7,4C517-- /U)
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
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DQ' NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date