ETHTE 12-5-29225
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: William Ezell Phone 270-839-0284
Address: 65 Adrian St. Holly Springs, NC 27540
Name of Mobile Home Park or S/D: Johnathan Ride lot 3
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and Truelove
Purpose of Inspection: Finish 2nd floor
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
Z / q 2--
Date