ETHTE #: 13 -5 -30677
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Angela Lee Harris Phone #: 574 -5743
Address: 3165 Beaver Dam Rd Erwin NC 28339
Name of Mobile Home Park or S /D: Levander Smith lot 3
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): 1779 Beaver Dam Rd
Purpose of Inspection: Mod (41'06')
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 . MA 1 10,41 '. 0
AUTHORIZATION OF EXISTING SYSTEM
I
Signature of Environmental'Malth Specialist ° # Date