ETHTE 11-5-27684
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Refuge Tabernacle of Deliverance Phone
Address: PO Box 298
Name of Mobile Home Park or S/D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and ft NC27
Purpose of Inspection: 24'x36' Classroom - Non-Water Generatin F~ acility.
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.
IS INSPECTION IS V® .
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 5' FROM ANY PART OF SEPTIC SYSTEM
NOT DRIVE PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
v~
is
Signature of Environmental Health