ETHTE #: 14 -5 -33987
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Doug McKenzie Phone #: 215 -7170
Address: 164 Green Haven Ln Carthage NC 28327
Name of Mobile Home Park or S /D:
Name of Owner (if different): Faith Baptist Church
Address of Owner (if different): 824 Claude White Rd Cameron NC 28326
Property Location (State Road name and #): Claude White Rd
Purpose of Inspection: Additon (25'x65') Front Entrance (10'x12')
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
1 • �. .
-3 L311 ILI] 'M WIN PROVIEW I W 11001"' 1013
AUTHORIZATION OF EXISTING SYSTEM
IdIS
Signature of Environments th Specialist