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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /314x- c. / , �% G,)eYdC PHONE# 915- 7�7- �'n7
ADDRESSt( /U /'J2o (? �i F �Y`�Jkce �C� �%' C • 7-7 3-V )
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7) H,Sy ruin c — (:!27 LA) X,7L/', /LJ, C 77SIk
PROPERTY LOCATION: STATE ROAD NAME AND #5f.L /YlS%4S-4el CffVeeG(/
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