ETHTE 09-5-22580
Name: Southern Custom Construction Phone 890-1504
Address: PO Box 254 Erwin NC 28339
Name of Mobile Home Park or S/D:
Name of Owner (if different): Robert Lee Jr,
Address of Owner (if different): 5774 NC Erwin NC 28339
Property Location (State Road name and 1779 Beaver Dam Rd
Purpose of Inspection: Garage
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
Signature
Date
(Ls
0'1,