ETHTE #: 16-5-38017
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Calvin Tenn Phone #: 528-1153
Address: PO Box 702 Vass NC 28394
Name of Mobile Home Park or S/D: Cypress Point lot 8
Name of Owner (if different): David Sergent
Address of Owner (if different): 50 Highhgeen Point Cameron NC 28326
Property Location (State Road name and ft 50 High¢reen Point
Purpose of Inspection: Covered Porch (14'x16')
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
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Signature of Environmental He'a44 Specialist
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