ETHTE 12-5-29287
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Pearl Swan Phone 90-981-5750
Address: 960 Springfield St #B Upland CA 91789
Name of Mobile Home Park or S/D: Anderson Creek Homes Sec 2 lot 106
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and Finley St
Purpose of Inspection: Man Home Placement (16'x76')
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 V® .
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 ' FROM A PART OF SEPTIC SYSTEM
NOT DRIVE OR A N SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
A 1-6-
Signature of Environmental Hea Specialist
Date