ETHTE 10-5-23625
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Alice Boyd
EXISTING SEPTIC SYSTEM INSPECTION
Phone 893-9438
Address: 1055 Adcock Rd Lillington, NC 27546
Name of Mobile Home Park or S/D:
Name of Owner (if different): Clyde Dennis
Address of Owner (if different): 1073 Antioch Ch Rd Lillington NC 27546
Property Location (State Road name and 1253 Adcock Rd
Purpose of Inspection: Home Replacement
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
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmental He th eciali