ETHTE I1-5-27094
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Jesus Ruiz Phone 919-258-5481
Address: 105 Pineland Dr. Broadway, NC 27505
Name of Mobile Home Park or S/D: Cool Springs Est. Lot?
Name of Owner (if different): Johnny Faircloth
Address of Owner (if different): 5272 Cool Springs Rd. Broadway, NC 27505
Property Location (State Road name and Cool Springs
Purpose of Inspection: Garage
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
:AC -J
Signature ofrnvironmental Health Specialist
12-",(l
Date