ETHTE #: 13 -5 -30946
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Russell Arnold Phone #: 919- 770 -0176
Address: PO Box 219 Broadway NC 27505
Name of Mobile Home Park or S /D: Riverbend lot 19
Name of Owner (if different):
Address of Owner (if different): 566 Lower River Rd Broadway NC 27505
Property Location (State Road name and #): Lower River Rd
Purpose of Inspection: Inground Pool (18'x32')
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
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1! 1 1' 1'`' '• ' 1
UTHORIZATION OF EXISTING SYSTEM
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Signature of Environmental Health
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