ETHTE #: 13 -5 -30538
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Edward /Mike Smith Phone #: 309 -9441
Address: 10 Hayden Ln Cameron NC 28326
Name of Mobile Home Park or S /D: RL Holder
Name of Owner (if different): Edward & Ruby Smith
Address of Owner (if different): 833 Docs Rd Lillington NC 27546
Property Location (State Road name and #): Docs Rd
Purpose of Inspection: Enclosure (12'x25')
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 BE • / ANY •
DO NOT DRIVE • •
AUTHORIZATION OF EXISTING SYSTEM
R I
s
Signature of Environmental HeAdopecialist Date