ET RHTE #: 14-5-35214R
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Valorie Benn Phone #: 571-276-4680
Address: 469 McKoy Town Rd. Cameron, NC 28326
Name of Mobile Home Park or S/D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): McKoy Town Rd
Purpose of Inspection: front and rear decks (built prior to inspection)
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
1
1� 1'111 LTA W03'!' 6,13 11A M13910'
AUTHORIZATION OF EXISTING SYSTEM
Signature of En ronmental Health Specialist
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Date