ETHTE #: 15-5-36071
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Jacques Robertson Phone #: 307-220-3808
Address: 317 William Dr Benson NC 27504
Name of Mobile Home Park or S/D: Kenlan Farms lot 26
Name of Owner (if different): Sean Summers
Address of Owner (if different): 220 Emma Ct Linden NC 28356
Property Location (State Road name and #): 220 Emma Ct
Purpose of Inspection: Deck (12'x12')
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
S
Signature of Environmental th Specialist
ate