ETHTE #: 14 -5 -33088
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Robert Kerley Phone #: 919 - 478 -6864
Address: 196 Still Pond Ln Cameron NC 28326
Name of Mobile Home Park or S /D:
Name of Owner (if different): Jackquline Worthy
Address of Owner (if different): 166 Still Pond Ln Cameron NC 28326
Property Location (State Road name and #): 27W
Purpose of Inspection: Man Home Placement (32'x68')
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
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmental Specialist (Date