ETHTE 10-5-25215
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLiNGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Ricky Elliott Phone 919-353-4592
Address: 684 Lower River Rd. Broadway NC 27505
Name of Mobile Home Park or S/D: River Bend lot 16
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and 1215 Rosser Pittman
Purpose of Inspection: New Home
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 Health Specialist
2- z_ 2C/o
Date