ETHTE 11-5-27662
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Elisabeth McLean Phone 919-770-3755
Address: 72 Elsie Buchanan Lane Broadway NC 27505
Name of Mobile Home Park or S/D: Cimmamon Hills lot 7
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and Lawrence 1272
Purpose of Inspection: Above round pool
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
C;-- e
Signature of Lnvironmental Health Specialist
a / 9 avj/
Date