ETHTE 10-5-24854
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Tony Wallace Phone 919-498-6690
Address: 266 J. Campbell Lane Sanford NC 27332
Name of Mobile Home Park or S/D: J. Campbell lot 266
Name of Owner (if different): Sherry & Randy Grissom
Address of Owner (if different): 5019 Ponderosa Rd. Sanford NC 27332
Property Location (State Road name and 1201 Ponderosa
Purpose of Inspection: Pool and deck
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
of-Environrnental Health Specialist
Date