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HTE #: 12 -5 -29758
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Kymberly Penson Phone #: 448 -8740
Address: 55 High Green Pt. Cameron NC 28326
Name of Mobile Home Park or S /D: Cypress Pointe lot 3
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #):
Purpose of Inspection: Storage Shed (10'x20')
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
1 1' NO
1' 'MANE V
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmental Specialist
ME
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