ETHTE 09-5-22367
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Shayne R. Mosteller Phone 528-7319
Address: 497
Name of Mobile Home Park or S/D: Outlaw Lane Cameron NC 28326
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and 1100 Line
Purpose of Inspection: MH Replacement
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
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
gnature of Environmental Health Specialist
",2-0,37
Date