ETHTE #: 16-5-40226
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Bettie A. Wilson Phone #: 919-552-0657
Address: 3717 Old Stage Road An 'er, NC
Name of Mobile Home Park or S/D: NA
Name of Owner (if different): Bettie A. Wilson
Address of Owner (if different): 1782 Purfov Rd. Fuquav-Varina, NC 27526
Property Location (State Road name and #): Old Stage Road N. (SR 1006)
Purpose of Inspection: New Mobile Home
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
Z-6-/7
nature of Environmental Health Specialist Date