ETHTE #: 14 -5 -33567
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Edward Smith Phone #: 309 -9441
Address: 833 Does Rd Lillington NC 27546
Name of Mobile Home Park or S /D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Docs Rd
Purpose of Inspection: Storage Building (24'x24')
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
1111
111111 Fill 1 Ii 1111111 1111111111
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmental ftb�V Specialist