ETHTE #: 18-5-44045
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Laura Dixon Phone #: 919-916-8277
Address: 100 Overby Ct Fuauay Varina NC 27526
Name of Mobile Home Park or S/D: River Pines lot 3
Name of Owner (if different): Lin Pei Chun Tic & Sung Hui Chun Tic
Address of Owner (if different): 2421 N Bell Ave Ant 103 Denton TX 76209
Property Location (State Road name and #): 1257 South River Rd
Purpose of Inspection: Man Home (16'x76')
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
5
Signature of EnvironmentA�ealth Specialist