ETHTE #: 12 -5 -29663
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Matthew Porter Phone #: 916 -2780
Address: 103 Mystic Ln Lillington NC 27546
Name of Mobile Home Park or S /D: Ava's Ridge lot 5
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): McDou alg d Rd
Purpose of Inspection: 24x24 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.n after six months
1 , • . , i
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Signature of En
AUTHORIZATION OF EXISTING SYSTEM
Specialist