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HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME oWC-6 Z�d Ile A,,6j PHONE # L1 Y-li y—y7o%
ADDRESS/J?rD ��.l. ii � 2�a � QLD /9iti GC¢,r� Z.75V/
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEPENT)
ADDRESS OF OWNER (IF DIFFERENT) :Z/ D C
PROPERTY LOCATION: STATE ROAD NAME AND # _
0
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