ETHTE #: 14 -5 -33458
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Daniel Thomas Phone #: 984 -4858
Address: 51 Mamie Ferguson Dr Lillington NC 27546
Name of Mobile Home Park or S /D: Mamie Bell Ridge lot 3
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Old US421
Purpose of Inspection: Pole Barn (30'x30')
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
11201010 11 IN LTA We) , AN l
AUTHORIZATION OF EXISTING SYSTEM
as
Signature of Environment .ealth Specialist Date