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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME �*r+ n, a�-� L.3�wS�1 N-� '�� PHONE # 91 ni -Z-7'Y -
ADDRESS ° ad"^��''r>> ►9t n^-ui.� ."� vrJ� y'i 5-&Z,
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENI)r�
ADDRESS OF OWNER (IFDIFFERENI) ac' Sw-c-ee .� Dn2 r- ✓. fie- vzstti
PROPERTY LOCATION: STATE ROAD NAME AND #tel Y%V 1W
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:
DO -NOT DRIVE OR PARK ON SEPTIC SYSTEM,
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date