ETHTE #: 13 -5 -32044
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Robert Patterson Phone #: 919- 499 -8625
Address: 911 Lloyd Stewart Rd Broadway NC 27505
Name of Mobile Home Park or S /D: Joshua C Patterson
Name of Owner (if different): Ed Patterson
Address of Owner (if different):
Property Location (State Road name and #): Holly Springs Church Rd
Purpose of Inspection: Man. Home (24'x66')
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
414 LTA 0911 Oka WA ILA IL1,9110153 01 W I ML
AUTHORIZATION OF EXISTING SYSTEM
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Signaturebf Environmefit �fealth Specialist
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