ETHTE #: 13 -5 -32371
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Wayne & Grace Rouse Phone #: 919- 258 -3264
Address: 9102 Old 421 Broadway, NC 27505
Name of Mobile Home Park or S /D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): old 421
Purpose of Inspection: replace home
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
of Environmental Health Specialist Date