ET RHTE #: 12- 5- 3022OR
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Juan Gallardo Phone #: 919 - 478 -0466
Address: 118 Massa Ln Cameron NC 28326
Name of Mobile Home Park or S /D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Milton Welch Rd
Purpose of Inspection: DW Placement (28'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
1 '� �. MNNLVA 1112011110 1. 1'. VA N 1
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmental Heattli S;rpecialist