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ETHTE #: 13 -5 -31421 HARNETT COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH 307 CORNELIUS HARNETT BOULEVARD LILLINGTON, NC 27546 Name: James & Cassandra Walker Phone #: 910 -578 -9084 Address: 435 Brower Rd Cameron NC 28326 Name of Mobile Home Park or S /D: Name of Owner (if different): Address of Owner (if different): Property Location (State Road name and #): 1157 Brower Rd Purpose of Inspection: Mod (28'x76') 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 �' ''� '• 9 1 111110W U 10 W WHOM O Signature of Environmental TION OF EXISTING SYSTEM M Date