ET RHTE 10-5-238498
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Joey Diaz Phone 919-499-3617
Address: 70 Bay Point Sanford NC 27332
Name of Mobile Home Park or S/D: Mcleod Lot 7
Name of Owner (if different): Clyde Patterson
Address of Owner (if different): 4271 Leaflet Church Rd Broadway NC 27605
Property Location (State Road name and 1214 Mt Pisgah Church Rd
Purpose of Inspection: Reuse of Existing Tank for New House
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 UST 5'FROM A PART OF SEPTIC SYSTEM
NOT RIVE OR PARK ON SEPTIC SYSTEM
HAB.NETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
AUTHORIZATION OF EXISTING SYSTEM
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Signature of Environmental
Specialist