ETHTE #: 13 -5 -31127
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Robert Card Phone #: 919- 478 -1874
Address: PO Box 684 Broadway NC 27505
Name of Mobile Home Park or S /D: River Bend lot 11
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Lower River Rd
Purpose of Inspection: 1 bedroom addition + living space
pace
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
' • ' '
1112011A 0 "14 W 0900 " IM W•, O
Signature.of Environmen
AUTHORIZATION OF EXISTING SYSTEM
M
Specialist
0