ETHTE 09-5-22483
Name: Jeffrey L. Pope Phone 910-814-7475
Address: 2568 Old Buies Creek Rd. Angier NC 27501
Name of Mobile Home Park or S/D:
Name of Owner (if different): Mike & Donna McCoy
Address of Owner (if different): 919 McCormick Rd Sanford NC 27332
Property Location (State Road name and 1217 McCormick
Purpose of Inspection: addition
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
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
AUTHORIZATION OF EXISTING SYSTEM
ignature of En
Date
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Health Specialist