ETHTE 11-5-27697
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEP'T'IC SYSTEM INSPECTION
Name: Barbara Rid ell Phone 910-814-3876
Address: 61 Thomas Dickens Rd Lillington, NC 27546
Name of Mobile Home Park or S/D: Peach Farm Est Ph. 3
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and SR1291 Old US421
Purpose of Inspection: Family Care Group 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 UST E 5FROM A PART SEPTIC SYSTEM
NOT DRIVE OR PARK N SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
I ~
Signature of Environmental Heh Specialist
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