ETHTE 11-5-27980
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Elvis Faircloth Phone 919-499-8190
Address: 5104 Cool Springs Rd Broadway, NC 27505
Name of Mobile Home Park or S/D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and 1265 Cool Springs Rd
Purpose of Inspection: 30'x32 Garage
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 .
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 UST E 5'FROM ANY PART SEPTIC SYSTEM
NOT DRIVE A N SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
N--)v V-,, -P
Signature of Environmental Hea ecialist Date