ETHTE 12-5-29384
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Amy Cockman Phone 910-985-1370
Address: 4908 S River Rd Lillington NC 27546
Name of Mobile Home Park or S/D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and 1257 South River Rd
Purpose of Inspection: Den Addition (26'x24'
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 VD .
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 ' F ANY PART OF SEPTIC SYSTEM
NOT DRIVE OR PARK N SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmental dltl Specialist