ETHTE 11-5-25833
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Kevin Gregory Phone 910-658-2193
Address: 45 Nut Tree Circle Lillin lg__on, NC 27546
Name of Mobile Home Park or SID:
Name of Owner (if different): Church At Anderson Creek
Address of Owner (if different): 126 Archie St Spring Lake, NC 28390
Property Location (State Road name and Archie St
Purpose of Inspection: Change of use from daycare to food pantry/small group assembly
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 MIDST DE 5' FROM ANY PART OF SEPTIC SYSTEM
O NOT DRIVE O PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmental Health