ETHTE #: 12 -5 -30268
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Pearl Swan Phone #:
Address: 960 Springfield Upland CA 91786
Name of Mobile Home Park or S /D: Anderson Creek lot 84
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and ft Finley St
Purpose of Inspection: Man Home Replacement (14'x80')
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 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 change, and /or
4. after six months
Signature of Environme Health S
Date