ETHTE 11-5-27703
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Shannon Jackson Phone 910-514-7083
Address: 98 Reid Edward Lane Lillington NC 27546
Name of Mobile Home Park or S/D:
Name of Owner (if different): Patricia Smith
Address of Owner (if different): 56 Reid Edward Lane Lillington NC 27546
Property Location (State Road name and 27
Purpose of Inspection: SFD
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
L
of Environmental Health Specialist
1-2- 7 (z°/
Date