ETHTE #: 17-5-41949
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Paul Kosik Phone #: 919 770 9404
Address: 5542 Cokesbury Rd. Fuquay-Varina, NC 27526
Name of Mobile Home Park or S/D:
Name of Owner (if different): Same
Address of Owner (if different): Same
Property Location (State Road name and ft Cokesbury Road (SR 1403)
Purpose of Inspection: Accessory - Metal Storage Building (40'x70') - No bedroom/bathroom
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
Signature of Environmental Health Specialist Date