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ETHTE #: 14 -5 -33743 HARNETT COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH 307 CORNELIUS HARNETT BOULEVARD LILLINGTON, NC 27546 Name: Cheryl Lowe Phone #: 578 -2783 Address: 99 Dockery Ln 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 #): West Rd Purpose of Inspection: Man Home (14'x48') 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 6A.11 1 N W I I IS - AUTHORIZATION OF EXISTING SYSTEM Sol Signature oflnvironinen ealth Specialist ° ® Date