ETHTE #: 13 -5 -32093
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: James D Allen Phone #: 919 -499 -3936
Address: 5423 Broadway Rd Sanford NC 27332
Name of Mobile Home Park or S /D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): 1222 Broadway
Purpose of Inspection: Man. Home (14'x80')
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
t� 1' I I'A '• I t 10 W 01 W
AUTHORIZATION OF EXISTING SYSTEM
M
Signature of Environmental
0