ETHTE 11-5-27704
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Michael Brown Phone 252-281-4110
Address: 2604 Canal Drive NW Wilson, NC 27896
Name of Mobile Home Park or S/D:
Name of Owner (if different): Ralph Douglas
Address of Owner (if different): Sanford, NC 27330
Property Location (State Road name and 210
Purpose of Inspection: replace mh
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
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ignature of Environmental Health Specialist
Date