ETHTE #: 13 -5 -31068
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Tim & Clausen Phone #: 919- 426 -3297
Address: 2493 Hillmon Grove Rd. Cameron NC 28327
Name of Mobile Home Park or S /D: lot 2
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Hillmon Grove
Purpose of Inspection: barn
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
MCI 1 � � � .1 1
AUTHORIZATION OF EXISTING SYSTEM
ignature o ironmental Health Specialist
Date