ETHTE 12-5-29370
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Richard Ward Phone k 919-499-8761
Address: 304 Hemlock Dr. Sanford NC 27330
Name of Mobile Home Park or SID: DM Thomas lot 6
Name of Owner (if different): David Burton
Address of Owner (if different): 74 Pauline Circle Sanford NC 27332
Property Location (State Road name and Pauline Circle
Purpose of Inspection: House Placement (27'x45'
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 .
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 E ' FROM ANY PART SEPTIC SYSTEM
NOT DRIVE OR PARK N SEPTIC SYSTEM
Signature
AUTHORIZATION OF EXISTING SYSTEM
I -J-3 \2
Date