ETHTE 12-5-28580
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: M&R Assoc Phone 919-776-0129
Address: 2484 Cameron Dr Sanford NC 27334
Name of Mobile Home Park or S/D:
Name of Owner (if different): Doris Clough
Address of Owner (if different): 1912 E24th Street Lawrence KS 66046
Property Location (State Road name and Ponderosa Rd
Purpose of Inspection: Front Deck and Ramti
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 ILF:
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 E 5' FROM A PART SEPTIC SYSTEM
NOT DRIVE OR PARK N SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Date
Signature