ETHTE 11-5-26169
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Ramon Velez Phone
Address: 118 Raibow Ct
Name of Mobile Home Park or S/D: AC Homes lot 163
Name of Owner (if different): Maris Velez
Address of Owner (if different):
Property Location (State Road name and Finley S
Purpose of Inspection: Man Home Placement (14'x74')
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 UST BE 5' FRO ANY ART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
ATION OF EXISTING SYSTEM
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Signature