ETHTE #: 13 -5 -32212
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: David & Brandy Farlow Phone #: 919 -774 -1175
Address:
Name of Mobile Home Park or S /D:
Name of Owner (if different): Grover Ellis
Address of Owner (if different): 17163 NC27W Sanford NC 27530
Property Location (State Road name and #): 126 Allen Rd
Purpose of Inspection: Man Home Placement (14'x66')
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
CA W WD) WAIRCH 01010M '
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmental Specialist
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