ETHTE 09-5-22904 &22903
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Patrick Griffin Phone 910-984-6390
Address: 1053 Brickmill Rd. Coats NC 27521
Name of Mobile Home Park or S/D: Myrtle Wood lot 14
Name of Owner (if different): Joanne Walker
Address of Owner (if different): 331 Green Forest Ct. Erwin, NC 28339
Property Location (State Road name and 421
Purpose of Inspection: Garage & Pool
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
ignature of Environmental Health Specialist
7U /oo
Date