ETHTE #: 18-5-44035: 18-5-44138
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Jonathan Beasley Phone #: 910.891.8189
Address: 2188 Ebenezer Church Road Coats, NC 27521
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 #): 2188 Ebenezer Church Road (SR 1558)
Purpose of Inspection: Accessory Detached Barns (20'x16'): (8'x16'). No bathroom. No
bedrooms. Proposed buildings not within septic field or septic setbacks.
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
C Iy I acA�3
Date