ET RHTE 07-5-17471R
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Cheryl Schumacher Phone 919-498-1039
Address: 479 DL Phillips Ln Broadway NC 27505
Name of Mobile Home Park or S/D: Carlton C Robertson
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and 1139 Tingen Rd
Purpose of Inspection: Pool Deck (Exisiting)
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If the system should malfunction, the owner is responsible for any
necessary repairs.
THIS INSPECTION IS VOID .
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 change, and/or
4. after six months
BUILDING UST E 5' FROM A PART SEPTIC SYSTEM
NOT DRIVE A N SEPTIC SYSTEM
TION OF EXISTING SYSTEM
Signature of Environmental Health
I
Date